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FOR MINNESOTA’S VETERINARY COMMUNITY FROM BLUEPEARL VETERINARY PARTNERS
Once Bitten, Twice Shy
DOG AND CAT BITES are the most common risk we
face in our practices because we handle painful and
frightened animals every day. Despite our best efforts
at being vigilant, it is nearly impossible to avoid this
risk. The compassion we feel for our patients is a
hindrance in this respect.
In a veterinary hospital, most bites occur to the
hands and, less commonly, to the arms. Bites to the
face also occur due to our proximity to the patient’s
mouth when we lift, carry or reach for the pet.
What’s the risk?
Because of their smooth teeth and strong jaws, dogs
inflict injury primarily by crushing and tearing tissues
below the skin, such as muscle, tendons and nerves.
By contrast, cats have sharp canine teeth that produce
punctures into deeper tissue, introducing bacteria into
these tissues and the blood stream. Because cat bites
create only small skin punctures, it is difficult for these
deeper wounds to drain.
Secondary infections are a common complication
of bite injuries. A mix of anaerobic and aerobic
bacteria from the animal’s oral cavity is frequently
identified. Pasteurella multocida is one of the most
common bacteria isolated from both dog and cat bites.
Less common, but of serious concern, would be the
presence of methicillin-resistant Stapylococcus aureus,
Bartonella henselae (the cause of cat scratch fever),
and rabies virus.
Do Not Take Chances! All dogs and cats
bite. Despite giving the impression that you may lack
compassion, use a muzzle or other means to protect
yourself from all trauma presentations and patients with
uncertain dispositions. You should constantly be reading
the patient’s appearance for signs that he or she may
bite. Don’t be afraid to ask for help with restraint of a
patient even if you are not certain it is needed. And don’t
be afraid to inform the clinician on duty that sedation
may be needed to perform an exam or treatment.
I’ve been bitten. Now what?
Should you be bitten by a dog or cat, you should wash
the wound as soon as possible with soap and water.
Inform the individual in charge. In most cases you
should seek prompt medical attention from a human
physician. Secondary infections from cat bites are very
common, and can develop very quickly (within hours) into
severe infections. Broad-spectrum antibiotics such as
amoxicillin-clavulanate are most commonly prescribed.
True or False: The mouth of a dog or cat is
cleaner than that of a human.
The answer is false. The microbial population in
the mouth of dogs and cats includes the resident
population as well as transient micro-organisms
introduced from what the cat or dog most recently ate
or licked. Realizing that animals, especially dogs, will
lick and chew most anything (dead animals, feces,
etc.), it makes you second guess accepting their kisses.
For the record, dog breath is caused by the gases given
off by microbials in their mouths.
b lu ep ea rlve t.co m
FALL 2015
How Is Cancer Treated?
THE FIELD OF VETERINARY ONCOLOGY is changing rapidly. Effective therapies, longer remission times, and
improved quality of life are now available for cancers that were once considered untreatable. These include
surgery, radiation therapy and chemotherapy.
Surgery
Surgery is the surest way to cure a tumor, but only if it can be removed entirely. This may not be possible without
significantly harming the tissues surrounding the mass. Many tumors are invasive with microscopic “roots” that
invade surrounding tissues. For this reason, a buffer zone of normal appearing tissue around the tumor should also
be removed during the surgery. The larger this “margin,” the more likely the tumor can be completely excised. If
metastatic lesions are present, then surgery is typically not the best option.
Surgery can also be performed to “debulk” a tumor. That is, the goal of
the surgery is to remove as much of the tumor as possible, although the surgeon
knows a portion will remain. This would be performed to improve the patient’s
quality of life, even though it would not cure the patient of the cancer.
Radiation therapy or chemotherapy may be used after surgery to kill the
remaining tumor cells or slow the tumor’s continued growth, especially if it
has already spread.
Radiation Therapy
The high energy waves used in radiation therapy kill cancer cells.
Damage to the cancer cell results from the direct disruption of electrons
within the DNA molecules and indirectly from damage caused by free
radicals formed when the radiation reacts with water molecules within
the cancer cells. The damaged DNA causes the cancer cells to die as
they attempt to divide.
Both normal cells and cancer cells are affected by radiation
therapy. Cancer cells are preferentially killed because they divide
more rapidly than normal cells and don’t repair themselves of the DNA
damage as well as normal cells do.
An advantage to radiation therapy is the ability to focus the
energy waves directly at the tumor and surrounding tissues where
microscopic disease may exist. Radiation therapy can be used as
adjunctive treatment after the surgical debulking of a tumor or as a
stand-alone treatment for those cancer types that have been shown to
be easily killed by radiation.
Surgically removing a splenic
tumor from a cat.
Radiation therapy can be very effective
for treating nasal lymphoma in cats.
Chemotherapy
Precautions are taken to protect the staff
Chemotherapy, in which medications are used to treat cancer cells,
when administering chemotherapy.
typically targets all rapidly dividing cells. Chemotherapy acts by
interfering with the ability of cancer cells to divide, damaging their
DNA, and/or limiting their access to required nutrients. Cancer cells, unlike normal body cells, have less capacity
for repairing themselves after being injured and therefore are more susceptible to the actions of the anticancer
medications.
However, chemotherapy will also affect normal rapidly dividing cells in the body. The side effects
associated with chemotherapy are a result of damage to the normal cells lining the GI tract (vomiting, diarrhea,
appetite loss), within the hair follicles (thinning hair coat), as well as white blood cells in the bone marrow
(an increased susceptibility to infections). Side effects can be minimized by controlling the dosages of the
medications administered and by administering a regimen of multiple medications having non-additive side
effects to kill the cancer cells. An advantage to chemotherapy is its ability to travel throughout the body killing
cancer cells that have metastasized to multiple locations.
If you have any questions about the cancer treatments available
at BluePearl, please call the hospital and speak with Dr. Joanna
Schmidt from our oncology service. She would be happy to discuss
your cancer cases with you.
Eden Prairie
Blaine
7717 Flying Cloud Drive
11850 Aberdeen Street NE
Eden Prairie MN 55344
Blaine MN 55449
952.942.8272763.754.5000
Indications for Arthroscopy
SNIFF…
Meet Dr. Kathryn Kaufman
Surgery Service
“My father was a
paramedic, and he would
tell us of stories from
work. From listening to
him I fell in love with
medicine and learned that
the healing capabilities of
a body could be amazing.
As a kid I was always intrigued with animals as well,
their kind nature, honesty and love. I wanted to help those
that helped me get through some tough times, and this is
the best way to do so!”
Dr Kaufman earned her doctor of veterinary
medicine from Iowa State University and completed three
internships prior to finishing a residency in animal surgery
at Texas A & M University.
Away from surgery she enjoys spending time with her
husband and their two dogs Isabella, a 3-year-old pit bull/
boxer mix, who loves to sleep under the covers, and Keela,
an 8-year-old German shorthaired pointer, who loves, loves,
loves to hunt! When she’s not spending time with her family
she enjoys antiques and has a soft spot for Starbucks. As
a Midwest native she is happy to be closer to friends and
family and doesn’t mind Minnesota’s snowy winters.
We are excited to have Dr. Kaufman join us at
BluePearl. We asked her a couple of questions about what
keeps her interested day after day and her thoughts about
surgery, so you could get to know her better.
What interests you most about surgery?
I enjoy veterinary surgery in all areas of orthopedics and
soft tissue, but one area that I am especially interested in
is arthroscopy. It is a very helpful tool not only diagnosing
problems but treating them as well. I was trained
extensively in the use of arthroscopy at Texas A&M during
my residency and find it most beneficial in diseases of the
stifle, elbow and shoulder. I feel the magnification and
light offered with arthroscopy helps me better diagnose
and treat the joint problem. I also feel that my patients
are much more comfortable with after-surgery and recover
more quickly. Many think that size of the patient may be
limited with the use of arthroscopy; however, with the tools
we have available at BluePearl we can use arthroscopy for
patients ranging in size from a Yorkie to a great Dane. The
most common diseases that we evaluate and treat include
cranial cruciate disease and meniscal damage of the stifle,
elbow dysplasia, biceps tenosynovitis of the shoulder and
OCD of multiple joints.
How do you collaborate with the primary care veterinarian?
I strongly believe in keeping the primary care veterinarian
updated. Asking if they have questions or concerns is
important to building strong relationships. I have been told
I have a good listening ear, am dedicated, innovative, and
a good person to bounce ideas off of, and it is with those
qualities that I want to encourage the referring community
to reach out to me for questions about cases or other
areas of interest. I’m excited to be a BluePearl doctor and
supporting my team!
Medical Director:
Jenifer Myers DVM
Hospital Administrator:
Mary Lecy
CRITICAL CARE
Tracy Julius DVM, DACVECC
Katherine Peterson DVM, DACVECC
Mallory Salcedo DVM
DENTISTRY & ORAL SURGERY
Emily Edstrom DVM
Donnell Hansen DVM, DAVDC
DIAGNOSTIC IMAGING
Megan MacLellan DVM
VETERINARY ARTHROSCOPY HAS GAINED popularity and enhanced our ability to
diagnose and treat many orthopedic diseases, including pathology of the shoulder,
elbow, carpus, stifle and hock.
Arthroscopy offers several advantages over traditional surgery, including
•• better visualization of structures within the joint by magnification,
•• minimal invasiveness and decreased pain, and
•• more rapid recovery.
Shoulder osteochondritis dissecans (OCD)
Shoulder arthroscopy is commonly used to diagnose and treat OCD, which often
presents as a unilateral lameness in young, large-breed dogs. However, the
contralateral limb is also affected in a large percentage of dogs.
Following bilateral radiographic screening, arthroscopy is ideal for confirming
the diagnosis and definitive treatment of OCD. After arthroscopic removal of the
cartilage fragments, curettage is performed within the articular cartilage defect to
stimulate fibrocartilage healing. Patients recover rapidly after this procedure.
Prognosis for OCD of the shoulder is good to excellent.
Bicipital tenosynovitis
This condition often presents as a unilateral lameness that may be chronic and
progressive in a middle-aged or older medium to large breed dog. Arthroscopy may
identify a partial or completely torn biceps tendon and/or fibrous proliferation and
osteophyte formation within the bicipital groove. Treatment includes biceps tendon
release. Patients treated for biceps tenosynovitis have a good to excellent prognosis if
pathology within the shoulder joint is limited.
Shoulder instability
Capsular or ligamentous injury leads to a chronic unilateral lameness, which is often
worse after exercise. This condition occurs in middle-aged dogs of any breed and size.
Diagnosis can be challenging and often requires heavy sedation and palpation
for laxity. Radiography identifies non-specific findings. Arthroscopy is recommended
to rule out other joint pathology and to confirm joint capsule and ligamentous tears.
Gross instability requires surgical stabilization with ligament reconstruction,
now commonly performed using bone anchors and non-absorbable suture material.
The prognosis for treatment of instability by arthroscopy and surgery is good if mild
to moderate disease exists but may be only fair with advanced disease.
Elbow dysplasia
Elbow dysplasia is commonly
characterized using arthroscopy
following identification on radiographs.
Components of elbow dysplasia often
diagnosed by arthroscopy include
fragmented medial coronoid process
(FCP), OCD, ununited anconeal process
(UAP) and elbow incongruity.
Since FCP is poorly recognized on
radiographic examination, it often goes
undiagnosed, which leads to progressive
osteoarthritis. Early diagnosis, prior
to advancement of osteoarthritis and
subsequent treatment by medial joint
assessment and removal of the fragment
along with medial coronoidectomy,
usually improves limb function.
Secondary humeral condylar
osteochondrosis, known as a kissing
lesion, cannot be seen on radiographs
and is often assessed and treated by
articular cartilage curettage.
INTERNAL MEDICINE
Alexis Cottingham DVM
Alyssa Mourning DVM, DACVIM
Jenifer Myers DVM
Sean Teichner DVM
Fragmented medial coronoid process (FCP)
Large fragmented medial coronoid process. Note
pathology of full thickness articular cartilage
defects of the humeral condyle (kissing lesion).
NEUROLOGY
Christina Wolf DVM, DACVIM
ONCOLOGY
Joanna Schmit DVM
OPHTHALMOLOGY
Nicole Trumble DVM, DACVO
Vaccines or Titers?
VACCINE PRODUCTS HAVE BEEN USED in companion animal medicine for
ARTHROSCOPY CAN BE USED TO ASSIST IN
ASSESSMENT FOR OTHER JOINT PATHOLOGY AND
PARTICULARLY IDENTIFIES A UAP LESION AS A LINE
OF FIBROUS TISSUE AND IRREGULAR CARTILAGE
BETWEEN THE ANCONEUS AND THE ULNA.
OCD of the medial humeral condyle is often identified on radiographs but
is best further characterized by arthroscopy. Once identified, the OCD flap can be
removed from its articular bed by graspers, followed by curettage of the subchondral
bone defect. Again, most patients have improved limb function following flap
removal, but this varies based on prior degenerative joint disease (DJD) presence.
UAP is usually recognized using radiography and treated either by anconeal
fragment removal or lag screw fixation. Arthroscopy can be used to assist in
assessment for other joint pathology and particularly identifies a UAP lesion as a line
of fibrous tissue and irregular cartilage between the anconeus and the ulna.
Lastly, elbow incongruity is a disease with controversy surrounding the ideal
diagnostics. It may be assessed by alignment of the radial head and ulnar trochlear
notch for step defects. Since this condition is often thought to contribute to FCP,
UAP and secondary humeral condylar osteochondrosis, medial corinoidectomy may be
considered to alter the joint biomechanics, particularly unloading the medial joint.
The outcome is often based on prior DJD advancement and may be fair to excellent.
Stifle joint
Arthroscopy is most commonly used for identification of cruciate ligament and
meniscal pathology in the stifle. In cases of suspected cranial cruciate ligament
disease that are lacking signs of instability, assessment of the ligament for partial
or complete tearing is easily done
arthroscopically. Additionally,
medial meniscal disease may
occur before or after stifle joint
surgical stabilization. Arthroscopic
assessment and treatment of
meniscal disease by debridement
can be done with limited morbidity.
Other indications for stifle
arthroscopy include diagnosis and
treatment of OCD of the lateral
and medial femoral condyles,
treatment of septic osteomyelitis and Cranial cruciate ligament tear (partial)
placement of transarticular pins.
Since the institution of arthroscopy for assessment of canine and feline
joint pathology, disease recognition and treatment outcomes have been enhanced.
Shoulder, elbow and stifle joints have numerous pathologies, which benefit greatly
from the reduced morbidity, recovery time and cost associated with arthroscopy. Early
identification of joint pathology and referral for further diagnostics and treatment will
undoubtedly benefit patients preventing progression of joint disease.
At BluePearl Veterinary Partners, our team is excited to offer
arthroscopy to your patients. If you have a case that you feel may
benefit from arthroscopy and would like to discuss the options,
please do not hesitate to call a member of our surgery team.
more than 40 years. They could arguably be considered one of the most
important scientific advancements that have helped us improve quality
and longevity of the life of our cat and dog patients. In the last decade,
a significant change in our thinking about vaccination protocols has
been seen due to several different factors. Our understanding of the
science of vaccination-induced immunity has evolved suggesting more
prolonged infectious disease protection with specific core vaccines
(canine distemper, parvovirus, adenovirus; feline panleukopenia virus).
Major veterinary associations (AAHA and AVMA) with the support of
vaccine amanufacturers now recommend reassessment of annual
vaccination protocols, especially for the core vaccines. Vaccination every
three years has become accepted practice by many veterinary practices.
Vaccine manufacturers have introduced new products with more extended
duration of immunity and fewer antigenic components.
Our society has become more concerned about possible vaccine
reactions in children, and this has also created concern over side effects
in pets. Side effects are fortunately infrequent in dogs and cats, but
there has been association between vaccination and the development of
vaccine sarcomas in cats and immune-mediated disease in dogs. With
the concern from pet owners about “over vaccination” and the possibility
of serious vaccine side effects, clients may now be requesting vaccine
titers instead of vaccines.
How reliable are these vaccine titers?
Vaccine titers have been the cornerstone of the change in our knowledge
about vaccine protection. They measure the presence of serum antibody
able to neutralize the virus and prevent infection. IgG is the antibody class
measured by vaccine titer assays. Studies have shown that for specific
viral diseases in dogs (parvovirus, distemper, adenovirus) and cats
(panleukopenia virus) protection after initial appropriate vaccination can
last for 4 to 10 years based on serologic titer results and challenge studies.
The “gold standard” assays for these virus titers are the viral
neutralizing titer (VIN) and hemagglutination inhibition (HI). Most state
diagnostic labs utilize the gold standard methodologies. Most, if not
all, commercial veterinary laboratories have qualified and standardized
alternative methodologies including enzyme immunoassays (ELISA) and
immunofluorescence assays (IFA) to provide similar titer information
compared to the gold standard VIN and HI assays. Due to variations
in lab assay methodologies, different reference ranges, and potential
change in titers from the pet over time, titers should not be compared
between different laboratories. In-clinic titer test kits for canine distemper,
parvovirus, and adenovirus and feline panleukopenia virus are now
available. TiterCHEK® (Zoetis) and VacciCheck® are the names of two
commercially available in-clinic titer kits. Both test kit systems have been
validated independently and correlated with the gold standard titer assays.
Rabies virus titers can also be assayed by the fluorescent antibody
virus neutralizing titer, but the assay is available only through a limited
number of certified laboratories.
How are these titers interpreted?
Depending on the individual lab and test methodology used, vaccine
titer results may be reported as “protective” or “positive” (high antibody
titer), “not protective” or “negative” (low antibody titer), or “borderline.”
Some assays will provide an actual titer level from the laboratory to use
in interpretation. The in-clinic titer test kits provide either a protected or
not-protected result (TiterCHEK) or a semi-quantitative score for serum
antibodies (VacciCheck). Protective, positive or high titers indicate that
there is a high antibody titer to that virus either from vaccination or
previous natural exposure or disease. For pets with a not protective,
negative or low titer, lack of virus protection is of concern and booster
vaccinations are recommended.
The best correlation between antibody and protective immunity
are for the viruses previously discussed (canine parvovirus, distemper,
adenovirus, feline panleukopenia, rabies).
It is important to remember that other factors may affect titer
interpretation and risk for the pet. The immune system is complex.
Antibodies target the foreign invaders for destruction, but other immune
system cells actually destroy the invader. An insufficiency in the cellmediated immune system (immunosuppression) may leave a pet at
risk for disease even if protective titers are present. Even if a titer is
considered low, exposure to the same antigen may result in a rapid
immune response with new antibodies produced within hours to days.
CONTINUED ON PAGE 4
SURGERY
Judith Feldsien BVMS, MVSc, DACVS-SA
Heather Hadley DVM, DACVS-SA
Andrew Jackson DVM, DACVS
Katie Kaufman DVM
Jeff Yu DVM, DACVS-SA
Vaccines or Titers?
CONTINUED FROM PAGE 3
These animals may be susceptible to infection but may be fully protected due to
immune-cell memory and cell-mediated immunity. By law, rabies vaccine titers
cannot be used in place of re-vaccination. When a rabies vaccination is not current, a
pet that bites someone must be considered unvaccinated and quarantined.
Antibody titers to vaccines other than the core viruses have limited or no
value as “protective titers.” Antibodies may persist for a short time, and there is no
correlation between serum antibody testing and protection. This includes antibody
testing for leptospirosis, feline herpes virus, feline calici virus, Lyme disease, and
Bordetella. With other diseases, feline immunodeficiency virus for example, titer levels
equate only to exposure to the pathogen or active infection.
What is the appropriate clinical application of these titers for the
veterinary patient?
Protective titer levels may be appropriate clinically for specific patients. The most
common application of vaccine titers is to help determine the need for vaccination
in an adult pet. The reason for the request for titer assessment is often because
of previous history of suspected or severe vaccine reactions in the pet, concurrent
medical illness or just the owner’s concern about the need for vaccination. Evaluation
of vaccine titers may be helpful to determine the need for core vaccines in other
clinical scenarios:
•• Evaluation of vaccine response in a young pet to help identify non-responders that
may not be able to produce a protective antibody response
•• Identification of possibly unprotected pets with recent exposure to a contagious viral
disease
•• Determination of antibody level in pet with unknown vaccination status
•• Management of infection risks and infectious disease outbreaks in shelters
Vaccine titers may be helpful in determining the need for specific vaccines
in the individual pet, but it is important that the owner understand the factors
other than titer results that may affect the decision to vaccinate. Each veterinarian
must determine the appropriate vaccination schedule for a patient based on risk of
exposure, age of the pet and current medical status of the pet.
Vaccine titers should not be considered a substitute for an appropriate core
vaccine protocol for most clinically healthy pets.
The recent outbreak of measles in children exposed to the virus at a national
amusement park was suspected to be correlated with a decline in vaccination
for this virus. This is a warning to us all and a reminder of the importance of
consistent vaccination for “herd health.” All puppies and kittens should complete the
recommended core vaccination protocols recommended with the last vaccine being
at or beyond 16 weeks of age. An evaluation of pathogen exposure risk, lifestyle, age
of the pet and concurrent medical problems along with vaccine titer status are all
factors that should affect the decision to vaccinate the individual adult pet.
We thank our colleague, Susan Yohn, DVM, MS, DAVBP Canine/Feline, DACVIM, from
BluePearl in Illinois for allowing us to se this article for Companion.
Companion
7717 Flying Cloud Drive
Eden Prairie MN 55344
To go green and receive only an electronic version of the COMPANION, or to add your email to our address list, please send an email to Jackie Todd, [email protected].
CONTINUING EDUCATION
BluePearl is strongly committed to the veterinary
community. One of the ways we demonstrate this
commitment is through our continuing education
program, which is subsidized in part by our
Partners in Education.
All BluePearl CE lectures are free and open to
all area veterinary professionals. Registration is
required, please; space is limited. Dinner will be
provided. To register, please email Jackie Todd
at [email protected]. For the most
current information about BluePearl CE, please
click the For Veterinarians tab on our homepage:
bluepearlvet.com/minnesota.
Date
Time
Type
Topic/Speaker
Oct 24
8AM
Dr/Office
Manager
Crown Plaza
Raking in CE for Veterinarians and Practice Managers
Plymouth
Multiple Speakers
Minnetonka
Community
Center
Nov 4
7PM
Dr/Tech
Interesting Imaging
Jen Myers, DVM
Nov 12
7PM
Dr/Tech
Interesting Imaging
Jen Myers, DVM
Location
Blaine Broadway
Pizza
CE
4 hr
1 hr
1 hr
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with support
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Partners
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If you would like
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please send
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at [email protected].
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© 2015 BluePearl Veterinary Partners