DR. GRUENHEID JOINS OUR SURGERY DEPARTMENT
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Here you’ll find answers to frequently asked questions from pet owners. Additional FAQ can be found on our Referring Veterinarians page
DR. GRUENHEID JOINS OUR SURGERY DEPARTMENT
Colleen Martin, DVM, MS, Practice Limited to Oncology
Wednesday, September 26th, 2018
This lecture will review:
Lecture provides 1 credit of complimentary CE to veterinarians and veterinary technicians through RACE.
Complimentary dinner and Meet & Greet starts at 6:00pm. Session begins at 7:00pm followed by Q&A.
340 Lancaster Ave
Malvern, PA 19355
RSVP by Friday, September 21st.
Overview: Fecal transplantation (or transfaunation) involves the deposition of a relatively large volume of “normal” gut flora from one individual to another. This procedure is performed commonly in people associated with numerous conditions (especially Clostridium difficile infection following antimicrobial therapy) and in with relative frequency in ruminant veterinary patients. More recently, this procedure has been investigated in canine and feline patients as an adjunct to other therapies for various GI conditions.
History and Diagnostics: A 9-year-old female spayed Yorkshire terrier was initially referred to VRC in November 2017 for an abdominal ultrasound to investigate chronic diarrhea and weight loss over the course of three months that was unresponsive to therapy up until that point. She had been on multiple courses of standard symptomatic diarrhea therapies including metronidazole, tylosin, probiotics, diet trials, and ultimately prednisone without any significant improvement. Her diarrhea was significant enough to be causing low blood protein levels (protein losing enteropathy).
Her ultrasound revealed diffuse gastrointestinal thickening, and a second immunomodulatory medication (azathioprine) was added to her medication regimen. When no improvement in GI signs occurred following the addition of this medication, she was referred for an internal medicine consultation three weeks later. An endoscopic examination and biopsy of her GI tract was recommended but ultimately declined in favor of continued empirical treatment for a presumptive form of inflammatory bowel disease with associated protein loss since this condition is common in this breed.
While we can only surmise at the actual diagnosis given that an endoscopy was not performed, had we proceeded with this test, the results may have looked like the below image. This endoscopic image is from a similar dog diagnosed with lymphangiectasia, a condition that I thought may have been the patient’s underlying issue.
Figure 1: In this endoscopic image from another patient’s duodenum, numerous raised white nodules are visible, consistent with lacteal dilation which is often pathognomonic for a process like lymphangiectasia.
Figure 2: In this ultrasonographic image of another patient, multiple loops of small intestine are seen in longitudinal view. Present are numerous hyperechoic linear striations perpendicular to the lumen, consistent with lymphatic (lacteal) dilation.
The patient was switched from azathioprine to cyclosporine, but there was concern she was not even absorbing these medications. Injectable dexamethasone was initiated, but she continued to decline, reaching a lowest body weight of 9.4 lb (down from her highest of 17 lb in early 2017). At that point the decision was made to attempt a fecal transplant as a last resort before her owners were considering humane euthanasia due to the refractory nature of her disease.
Procedure: On March 20, 2018 the patient was very lightly sedated with an intravenous dose of butorphanol. The previously screened fecal donor (another VRC employee pet) provided a fresh bowel movement the morning of the procedure. A portion of this was mixed 1:4 with saline and blenderized prior to being strained in order to remove larger particles from suspension. A total volume of 10 mL/kg fecal solution was instilled via a 12 Fr red rubber catheter as far into the patient’s colon as possible, and she was kept from having a bowel movement for as long as possible to provide more contact time. An alternative option is to perform fecal transplantation under general anesthesia, occasionally at the time of endoscopic examination (which allows for deposition of fecal solution into both the duodenum and the colon).
Immediate Outcome: Following discharge, the patient’s bowel movements began to improve almost immediately. She was subsequently tapered off of injectable dexamethasone, without the need to resume oral prednisone therapy. Her other treatments were discontinued one after another, with no deterioration in her condition at that time.
Discussion: Fecal transplantation is a very appealing option for dogs and cats with refractory diarrhea given the relatively low cost and risk associated with it compared to various other options. It is also being actively investigated as a potential therapy for numerous other non-gastrointestinal conditions including resistant urinary tract infections and other autoimmune disease processes. While not all patients may respond, this procedure seems to have significant potential. Fecal transplantation can be considered at any point in a patient’s therapy.
Summer is here, and we are slathering on the sunscreen, but our pets spend a lot of time outside with us, too. What about them? VRC wants you to know how important sun protection for pets can be and how to keep them safe in the summer sun.
Many pet owners are surprised to learn that their dogs and cats can get sunburns. However, our pets have skin just like we do, and that skin can only be protected by fur to an extent. If you are anticipating that your dog or cat will be out in the sun for extended periods of time, you should use pet-safe sunscreen on their skin.
Focus sunscreen application on the nose and ears, because these areas tend to have less fur and are more sensitive. Additionally, pets that have short hair, thin hair, no hair, or hair with little pigment are more likely to get sunburns, and therefore, these pets will need more sunscreen protection than some other pets may need. If you shave your pet, you will also want to make sure you protect the skin that is newly exposed to the sun. Avoid getting sunscreen in your pet’s eyes, however, as it can cause burning and irritation.
When it comes to applying sunscreen to your pet, you will want to make sure you get a pet-safe product. Many human sunscreens contain ingredients that can be toxic and cause gastrointestinal problems if they happen to be ingested by a pet. For these reasons, you don’t want to use a human sunscreen on your pet.
Instead, pet-safe sunscreens can be purchased. These sunscreens won’t contain zinc oxide, but they will help prevent sunburn. Look for a sunscreen that is fragrance-free and waterproof. A good sunscreen blocks both UVA and UVB rays and has an SPF of at least 15. A few of the more common pet sunscreens are Virbac Pet Guard Gel with Sunscreen, which is safe for both cats and dogs, and Doggles Pet Sunscreen, which can be used on dogs.
Much like human sunscreen, pet sunscreens can be sprays, gels, or creams, so you may want to determine which product is going to be easier for you to apply to your pet based on their personality. You want to try to keep your pet from ingesting and inhaling the sunscreen the best you can. Sunscreens should be reapplied every three or four hours unless your dog is in the water, in which case you should reapply the sunscreen more frequently.
If your pet isn’t going to respond well to sunscreen, you can get special attire for your pet to prevent sunburns. Solar-protective clothing ranging from eyewear to shirts to hats can help prevent problems for your dog or cat when they are out in the sun.
For pets that like to spend a lot of time outside in the summer, there are covers that can be placed on exercise pens that can prevent sunburns. They function like beach umbrellas that block the sun’s rays from hitting the skin.
The most immediate risk associated with sun exposure for our pets is sunburn. Much like humans, dogs and cats find sunburns to be painful, and they can also experience skin peeling. Severe sunburns can even lead to infections that are tricky to treat and extremely painful for your pet.
Skin cancer is also a problem for our furry friends. Using sunscreen is important to prevent damage to the skin from the sun that can lead to cancer. Skin cancer can be painful and life-threatening, so it is important that pet owners try their best to prevent sunburns in their pets.
Sun protection is extremely important, but just because your pet is protected from the sun’s rays doesn’t mean that it isn’t at risk for heatstroke. Heatstroke is very dangerous for pets, and you need to make sure that your pet has access to shade and water if you are going to be outside in the heat for an extended period of time.
Avoid bringing your pet outdoors during the hottest time of day, and if you can, leave your pet at home to avoid any risk of being left in a place without access to shade, water, or air conditioning.
VRC knows that accidents and unexpected situations arise, so if your pet does seem to have a sunburn or heatstroke, bring them in right away if you are in the Philadelphia area. Sun protection for pets isn’t always easy to figure out, so give us a call at 610-647-2950 if you have any questions about keeping your pet safe in the sun.