beat ISSUE 10 | JULY 2021
QUARTERLY BEAT / JULY 2021 ///
CONTENTS July 2021
06 Dilution May Be the Optimal Solution for Cats With Lower Urinary Tract Disease 10 5-FU Toxicity in Dogs 12 Emotional Wellness: Why Dark Emotions are Just as Important as Warm & Fuzzy Ones 14 Making Sense of Common Muscle and Tendon Injuries in Dogs
16 UPCOMING CONTENT 18 TECH TIPS 21 PROVIDER SPOTLIGHT WHAT’S NEW
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A NOTE FROM VETgirl
Garret and I are excited to bring you the newest edition of our VETgirl BEAT E-magazine! And with it, we have some big news… so keep reading...
Back in 2012, I had the amazing opportunity to lecture in India. While visiting, I helped some veterinarians perform a thoracocentesis on a HBC dog. One of the veterinarians said to me that they thought it was one of the first thoracocentesis procedures done in the country. While I’m sure that wasn’t true, it made me feel fortunate to have the opportunity to elevate the quality of emergency critical care globally. That same year, I reached out to fellow tech-savvy PennVet ECC resident, Dr. Garret Pachtinger, with a crazy idea that I had been simmering for almost a decade… being able to provide education in a format never used before – online continuing education (CE) . Little did I know, we’d be one of the first online veterinary CE providers out there. Our goal and passion? To deliver clinically relevant, practical CE. Because we wanted our veterinary colleagues to take away 2-3 “learning points” per lecture that was going to directly help save that patient’s life. That way you could learn anywhere, regardless of where you were. Like in India. Through the help of fellow resident mates and colleagues, along with our continued passion for delivering clinically relevant, practical CE, it’s been an honor to see VETgirl continue to grow. And grow, we did. Over the past 8 years, we’ve expanded from just small animal to add more opportunities to learn: large animal, veterinary technician, leadership, practice management, nutrition, certificates, LIVE conferences and so much more. That’s why we decided to team up with BluePearl and become part of Mars Veterinary Health. This partnership will help us take VETgirl to the next level. Please know that this won’t fundamentally change anything about what we do and love here at VETgirl. Garret and I will still be at the helm, ensuring our content stays clinically relevant. Practical. Lifesaving. And unbiased.
Let’s elevate the quality of veterinary medicine worldwide. It took us almost a decade to grow it in North America, and we still have a long way to go. But, reflecting back on my veterinary visit to India, I wanted to help bring VETgirl’s CE to a more international level. And we wouldn’t be able to take it global without them. Our view? Why not expand to help save HBC’s needing that thoracocentesis around even the most remote corners of the world? Because our patients deserve better. By partnering with BluePearl and Mars Veterinary Health, it’ll allow us to provide unprecedented opportunities, support, and access to high quality education to all veterinary professionals, national and international. We’ll be able to raise the level of education and expand our community globally. We firmly believe that joining the Mars Veterinary Health family brings only positive changes for the veterinary community. It will certainly make the company stronger and the increased resources will ensure that we are more capable of providing quality, clinically relevant, practical, unbiased, and convenient education as well as an improved user experience - not just better technology, but more content offered in different languages, with closed captioning and transcriptions to make it even easier to learn. We have always been passionate about giving back to our veterinary community - with free, sponsored CE, with decade-long support for several Diversity, Equity & Inclusion scholarships at veterinary schools, with stress-relieving social media humor, with our boutique veterinary conference for our most loyal, with our first ever-hire being prioritized as our Chief Happiness Officer and licensed social worker. Because we truly love our veterinary community.
Thank you for all that you do. Thank you for loving to learn and for always striving to save that patient’s life. We’re not going anywhere. Thank you for trusting us to continue to learn with us.
Deepest regards, Justine & Garret
GARRET PACHTINGER VMD, DACVECC COO, VETgirl
JUSTINE A. LEE DVM, DACVECC, DABT CEO, VETgirl
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QUARTERLY BEAT / JULY 2021 ///
CAMILLE TORRES-HENDERSON , DVM, DABVP (Canine and Feline) Dilution May Be the Optimal Solution for Cats With Lower Urinary Tract Disease
Managing cats with lower urinary tract disease (LUTD) can be one of the more vexing problems you encounter as a veterinarian. But here’s the good news: We’re learning more about some of the potential causes of LUTD and, in some cases, are able to employ less-invasive ways to manage cats with this issue.
WHAT CATS ARE MOST AT RISK? Factors as diverse as neuter status, stress and weight can figure prominently into whether or not a cat develops LUTD. A study examined the risk factors for LUTD in cats and found that the proportional morbidity rates of cats developing LUTD, irrespective of cause, was 8 in 100 cats. 1 Here’s what this and other studies have revealed: • It’s a weighty matter. Cats with feline idiopathic cystitis (FIC)—inflammation of the urinary bladder with no identifiable cause—were significantly more likely to be overweight compared to both healthy cats in the same household and a control population of clinically healthy cats. 2 • Neutering is associated with the development of LUTD. Castrated males are at increased risk for each cause of LUTD except urinary tract infection (UTI) and incontinence, while spayed females had increased risk for urocystolithiasis, UTI and neoplasia. 1 • Lack of exercise and low moisture intake are also culprits. Inactivity and foods with low moisture content may also increase the risk of urolith development. 3 Urolith formation may be the end result of several combined disorders, not all of which can be corrected even if they are identified. 4 Here’s an example: A cat has an elevated level of calcium in his or her urine. Add a stress factor such as environmental stress or lack of enrichment, then add obesity. Taken alone, these individual factors might not be directly linked to urolith formation. Combined, they could result in a stone forming. However, it’s often difficult to make connections between those contributing factors.
TYPES OF LUTD AND MANAGEMENT Two of the most common forms of LUTD are urolithiasis and FIC. While both can be managed, they have different causes and can require different courses of action. Urolithiasis The overarching goal in managing cats with urolithiasis is to use the least-invasive strategy possible. Therapeutic dissolution diets are formulated to dissolve struvite uroliths. Veterinarians are often concerned about taking time to dissolve stones through diet because of the risk of obstruction. I used to feel that way myself. However, the 2016 ACVIM consensus statement on the treatment and prevention of uroliths in both dogs and cats supports adopting a more conservative approach to determine if stones can be dissolved through diet as opposed to surgical removal. 5 Postponing surgery for several weeks to first try a diet formulated to dissolve struvite uroliths (in conjunction with pain management and antibiotic therapy, if appropriate) can potentially lead to a more positive outcome. We may be able to avoid unnecessarily anesthetizing the patient or traumatizing the bladder through surgery. Calcium oxalate stones cannot be dissolved, regardless of diet. Regardless of stone type, one of the most beneficial approaches practitioners can take in managing cats with a history of urolithiasis is to increase urine volume. Increasing the volume of urine in the bladder decreases the concentration of calculogenic (stone-forming) minerals and increases voiding frequency. Increasing urine volume is usually accomplished by boosting moisture intake.
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cats with FIC, feeding a canned diet and/or increasing liquid intake is the optimal way to achieve a lower urine specific gravity. If a patient accepts it, a hydration supplement can be a good way to help decrease a patient’s urine specific gravity. For example, there are nutrient-enriched water supplements available that promote healthy feline hydration and aid in the absorption of water at a cellular level. Given how common urinary conditions are in cats, it may be a good idea to encourage owners to offer their cats foods with a variety of textures when they’re young, as opposed to when they are older and may be conditioned to only eat dry foods. That’s not to say that rotating diets throughout a cat’s lifetime is necessary, only that exposing them to different textures at a young age is a good way to get them comfortable and hopefully promote acceptance. CHOOSING A THERAPEUTIC DISSOLUTION DIET The first step in choosing a therapeutic dissolution diet is to ascertain what type of stone has formed in the patient. Struvite stones can often be dissolved with diet, thereby avoiding the costs and risks associated with surgery and anesthesia. Sterile struvite uroliths in cats may dissolve as early as one to two weeks after transitioning to a therapeutic dissolution diet.
FIC In studies that have evaluated risk factors for cats with FIC, most report that feline patients that are male, approximately 2 to 7 years of age and/or overweight are at increased risk. 6 A variety of husbandry/environmental risk factors, such as indoor housing and increased stress, were also consistently found. 6 Because so many pets in the U.S. are spayed or neutered, and the number of overweight or obese pets increases every year, LUTD in cats may be on the rise. However, we’re also more aware of how to diagnose these conditions and manage these patients. So whether prevalence is increasing or we are now more proactive in diagnosing LUTD is an open question. UPPING DIETARY MOISTURE LEVELS Cats have a lower physiological thirst drive than dogs, so identifying other strategies to boost fluid intake is key. Increasing dietary moisture can increase urine volume and promote a more-dilute urine, which decreases the opportunity for crystals to form. The 2016 ACVIM consensus statement suggests that urine dilution is probably one of the best ways to help reduce the risk of urolith formation. 5 We can help owners boost cats’ moisture intake in a variety of ways, such as by recommending use of water fountains, adding water to dry food and feeding a canned diet, introduced gradually to help avoid gastrointestinal upset. For
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If there are no contraindications to trying a urinary diet, I recommend placing the cat on a two- to four-week trial with a diet that’s indicated for dissolution in addition to reducing the risk of struvite urolith formation. Veterinarians can initiate pain management for discomfort, treat with antibiotics if indicated based on urinalysis and culture, start the patient on a urinary diet, monitor progress, and then determine next steps based on radiographs and abdominal ultrasound. If the stones do not appear to be dissolving, surgical or minimally invasive removal options should be explored. Some therapeutic diets have undergone relative supersaturation (RSS) testing to ensure they promote a urinary environment that is unfavorable to the development of struvite and calcium oxalate crystals. However, many of these diets are not indicated for dissolution of struvite uroliths. There are diets available that 1) help dissolve struvite uroliths, 2) promote a urinary environment that is unfavorable to the development of both struvite uroliths and calcium oxalate uroliths, and 3) can be fed for maintenance of adult cats. Urine dilution may be an effective solution for many cats with LUTD. However, each patient’s clinical, behavioral and dietary history should be carefully evaluated to determine the best management plan. References 1. Lekcharoensuk C, Osborne CA, Lulich JP. Epidemiologic study of risk factors for lower urinary tract diseases in cats. J Am Vet Med Assoc . 2001;218:9:1429–1435. https://doi.org/10.2460/javma.2001.218.1429.
2. Cameron ME, Casey, RA, Bradshaw, JWS, et al. A study of environmental and behavioural factors that may be associated with feline idiopathic cystitis. J Small Anim Pract . 2004 Mar;45(3):144–7. https://doi.org/10.1111/j.1748-5827.2004.tb00216.x. 3. Jones BR, Sanson RL, Morris RS. Elucidating the risk factors of feline lower urinary tract disease. NZ Vet J . 1997;45:100–108. https://doi.org/10.1080/00480169.1997.36003 4. Bartges J, Callens A. Urolithiasis. Vet Clin North Am Small Anim Pract. 2015 Jul;45(4):747-68. doi: 10.1016/j.cvsm.2015.03.001. 5. Lulich JP, Berent AC, Adams LG, et al. ACVIM Small Animal Consensus Recommendations on the Treatment and Prevention of Uroliths in Dogs and Cats. J Vet Intern Med 2016;30:1564–1574. https://doi.org/10.1111/jvim.14559. 6. Forrester SD, Towell TL. Feline Idiopathic Cystitis. Vet Clin Small Anim 2015;45:783–806. http://dx.doi.org/10.1016/j.cvsm.2015.02.007 Camille Torres-Henderson, DVM, DABVP (Canine and Feline) is an assistant professor of small animal nutrition at Colorado State University Veterinary Teaching Hospital.
WHAT IF… WE COULD DISSOLVE STRUVITE STONES AS EARLY AS TWOWEEKS?
When it comes to urinary stones, every day matters. In a Purina study, Purina ® Pro Plan ® Veterinary Diets UR Urinary ® St/Ox ® dry appeared to dissolve presumed struvite cystoliths within two weeks. *
Wet variety pack also available
Helps dissolve struvite uroliths
Promotes a urinary environment unfavorable to the development of both struvite uroliths (undersaturated, RSS<1) and calcium oxalate uroliths (metastable RSS<12)
Helps reduce the risk of both struvite and calcium oxalate urolith recurrence
*Torres-Henderson C, Bunkers J, Contreras ET, et al. “Use of Purina Pro Plan Veterinary Diet UR Urinary St/Ox to Dissolve Struvite Cystoliths.” Top Companion Anim Med. 2017 Jun;32(2):49-54. Purina trademarks are owned by Société des Produits Nestlé S.A. 1-800-222-8387 (8:00 AM - 6:00 PM CST M-F) | Talk to your Purina Veterinary Consultant LEARN MORE AT PURINAPROPLANVETS.COM.
QUARTERLY BEAT / JULY 2021 ///
DR. JUSTINE LEE , DACVECC, DABT CEO, VETgirl, LLC 5-FU Toxicity in Dogs
In this VETgirl Real-Life Rounds webinar entitled “5-FU,” Dr. Justine Lee, DACVECC, DABT reviews the deadly topical toxin, 5-FU.
5-FLUOROURACIL (5-FU) 5-FU, commonly known by the brand names Efudex®, Carac®, Adrucil®, and Fluoroplex®, is a prescription anti-neoplastic medication that is often used for treatment of actinic keratosis or superficial basal cell carcinoma in humans. It is commonly sold in low concentration products (e.g., 0.5- 5%), and works by inhibiting DNA and RNA synthesis and production, resulting in programmed cell death. 1 While IV administration of 5-FU is occasionally used as a chemotherapeutic agent in dogs (e.g., for mammary gland tumor, etc.), it is not recommended for use in cats. Decades ago, topical 5-FU was used in cats for the treatment of squamous cell carcinoma; however, it resulted in severe toxicosis and death due to its narrow margin of safety. When dogs ingest 5-FU, clinical signs can develop quickly - within 30 minutes up to 6 hours; death has been reported as early as 7 hours. 1 Clinical signs and clinicopathologic abnormalities seen with 5-FU toxicosis in dogs include:
TOXIC DOSE The lowest reported toxic (oral) dose in dogs is 6 mg/kg, while the minimal reported lethal dose is 20 mg/kg. One case report did have a dog survive ingestion of 46 mg/kg of 5-FU. 1 That said, the prognosis with 5-FU toxicosis is typically grave in cats and guarded in dogs (with a reported survival in dogs of approximately 25%). Death typically occurs due to secondary complications from the 5-FU such as sepsis (due to leukopenia), increased intracranial pressure (due to persistent seizures), intracranial hemorrhage (due to severe thrombocytopenia), or DIC (due to severe seizures). Unfortunately, most patients present with severe clinical signs, where it is too late to perform decontamination. Therefore, treatment should be aimed at symptomatic supportive care, anti-convulsant therapy, anti-emetics, antidiarrheals, IV fluids (to help maintain perfusion), thermoregulation, broad-spectrum antibiotics, clinicopathologic monitoring, and symptomatic supportive care. If the patient is able to survive the acute crisis, clinicopathologic monitoring is necessary every 3-4 days thereafter for 2-3 weeks, until bone marrow function returns to normal. 1 References 1. Powell LL. 5-Fluorouracil. The Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology. Ames, IO: Wiley-Blackwell. pp. 164- 169. NOTE: When in doubt, all drug dosages should be confirmed and cross- referenced with a reference guide such as Plumb’s Veterinary Drug Handbook.
• hypersalivation • anorexia • vomiting • abdominal pain • diarrhea • bloody diarrhea • ataxia
• tremors • seizures • anemia or hemoconcentration • leukopenia • thrombocytopenia
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QUARTERLY BEAT / JULY 2021 ///
Emotional Wellness: Why Dark Emotions are Just as Important as Warm & Fuzzy Ones
JEANNINE MOGA , MA, MSW, LCSW Chief Happiness Officer, VETgirl, LLC
all emotions to be important signals, they not only feel less threatening, but also give us a clue about what to do when we feel them. And it’s the doing that brings us relief. A few caveats are necessary here. First, the emotional brain isn’t always accurate – it sometimes confuses “similar” with “same,” so our emotional responses don’t always fit the circumstance. If you’ve had a coworker fly off the handle after mis-interpreting something you said or did, chances are good the emotional brain was at work. Related, the emotional brain’s connection to the prefrontal cortex (where reasoning, problem-solving, and emotional regulation reside) is not always stable. In times of great stress, the PFC might be “off-line” and unavailable for immediate intervention. As a result, we might have to work extra hard to identify, and manage, our emotions when we are overwhelmed, exhausted, or otherwise saturated. Learning to pause, breathe, and ask yourself, “ What am I feeling ? And what do I need in this moment? ” can help, particularly when the emotions – and stakes – are high. Another important note: as much as we sometimes want to block out the dark emotions, it is impossible to do that without also blocking out the more positive aspects of our experience. Unfortunately, self-protective barriers do not have the capacity to selectively filter out *just* the things we don’t like 2 . Instead, engaging the entire emotional spectrum enables us to pick up on clues about what we need both more and less of in our lives. And here’s the paradox: the beauty of being human is that we are capable of holding multiple, sometimes conflicting, emotions in the same hand.We can feel grief and relief, joy and angst, or fear and hope simultaneously. Perhaps that’s the trick, then: to cultivate the capacity to balance the dark and the light without minimizing either of them or getting lost in the shadows. After all, it is the capacity to feel, and transform, our emotions that builds resilience. And isn’t that what we’re after, after all? 1 Panksepp, J., & Biven, L. (2012). The archaeology of mind: Neuroevolutionary origins of human emotions . New York: W.W. Norton & Company. 2 For instance, I have learned from experience that pinot noir neither amplifies good judgment nor eliminates self-judgment – an unfortunate discovery.
Positive Psychology, which focuses on positive human functioning and the strengths that enable people to live meaningful and fulfilling lives, has been getting a lot of traction and a load of press – for good reason. Americans, as a whole, are a chronically stressed out (and increasingly unhappy) bunch, and we’re searching for anything that will uplift us. On the whole, I’m a big fan of Positive Psychology and its focus on positive emotions and experiences. Who couldn’t use a little (or a lot) more joy, contentment and satisfaction? The danger comes when the messages of positive psychology are distilled into the shorter snippets most people consume (280 characters or less, anyone?). While I love reminders to cultivate moments of gratitude, joyful attention, and humor, I admittedly get a little worried when these reminders are misinterpreted as erasers for dark emotions and experiences. This is because understanding and attending to the dark emotions is equally important for our health and well-being. Working with dark emotions feels dicey because they – anger, rage, grief, and fear among them – usually make us really, really uncomfortable. Most of us want those feelings to go away pronto, whether we feel them emerging from within us or experience them spilling out from a co-worker or client. Dark emotions can be frightening in their intensity, heavier in weight, and tougher to shake. Our difficulty working with these emotions is likely linked to all of the ways we try to smother, ignore, drown, and otherwise eliminate the feelings we’d rather not have. [Can I have my angst with a side order of pinot noir, please?] And self-destructive self-soothing leads to a whole other bucket of problems. But here’s the thing: ALL emotions (even the dark ones) are an important part of the human experience. Science has shown that there are seven emotional systems in the brain that result in both primary emotions (such as happiness, surprise, sadness, fear, anger, and disgust) and secondary emotions (the emotional response to having an emotion, such as feeling ashamed about feeling angry). All emotions are messages about what we need and what we need to do 1 . As such, emotions drive our behavior, influence our thinking, and either narrow or broaden our attention. If we consider
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Making Sense of Common Muscle and Tendon Injuries in Dogs
MICHAEL H. JAFFE , DVM, MS, CCRP, DACVS Mississippi State University College of Veterinary Medicine
In this VETgirl webinar entitled “Diagnosis and treatment of canine muscle and tendon injuries,” Dr. Michael Jaffe, DVM, MS, CCRP, DACVS reviews some of the most common muscle and tendon injuries in dogs such as calcanean tendon rupture, biceps tenosynovitis, supraspinatus tendon injuries, infraspinatus contracture, and iliopsoas muscle injuries. As a VETgirl ELITE member, watch it again HERE to learn how to diagnose and treat these musculoskeletal conditions and general aftercare.
Radiographs may be useful when a muscle injury is suspected. Although there may be concurrent injuries to bones and joints, muscle and tendon injuries frequently show subtle or no radiographic changes. It is important to obtain radiographs, however, to aid in ruling out other causes of lameness. Ultrasound is an underutilized but very valuable tool when tendon injury is suspected. For those not familiar with the radiographic appearance of the tendon in question, use of the contralateral limb (if it is clinically normal) may be of value in comparing tendons and assessing for changes. Mineralization noted on radiographs can also be better delineated as to which tendon has these changes. Frequently supraspinatus tendinopathies are misinterpreted on radiographs as biceps tenosynovitis. Ultrasound will help determine which tendon is affected. I have frequently noted mineralization in one of these tendons with secondary inflammation of the other indicating 2 tendons showing injury. Computed Tomography (CT) and MRI are sometimes utilized when muscle and tendon injuries are suspected. Whereas CT is not the best diagnostic tool for soft tissue injuries, contrast CT studies and non-contrast studies will show changes in the muscles of suspect. Use of MRI is often not easily obtained due to cost and accessibility; however, MRI is extremely valuable in noting muscle and tendon changes. Bicipital tenosynovitis is an inflammatory condition of the tendon of origin of the biceps brachii muscle. Inflammation of the tendon is typically due to repeated stress or trauma to the tendon. Clinical signs may be either a gradual onset or a progressive lameness that worsens with activity. Diagnosis is aided by palpation of pain over the tendon of origin with
There are generally 4 broad categories of injuries that cause lameness in dogs. My approach to a limping patient is to try to rule out each category when developing a list of rule-outs for the cause of lameness. These categories include: • Orthopedic injuries (bone and joints) • Neurologic injuries (think root signatures and peripheral nerve injuries) • Immune-mediated and infectious causes (immune-mediated polyarthritis, etc.) • Muscle and Tendon injuries Orthopedic injuries are generally ruled in or out via radiography. Neurologic causes for lameness are frequently identified via a good neurologic exam. Immune and infectious causes are challenging and may require arthrocentesis and blood titers. Muscle and tendon injuries are frequently frustrating and difficult to diagnose. There are 5 broad mechanisms of injuries that may occur to muscle and tendons:
• Contusions • Lacerations • Ruptures • Strains • Contracture/Fibrosis
Physical exam findings will often guide the clinician to consider muscle or tendon injuries as the cause of lameness. Patients are often partial to non-weight bearing lame, there may be swelling of the muscle present, muscles and tendons will be painful on manipulation and palpation, there may be decreased or increased range of motion in the joint, and disuse atrophy may be noted.
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the shoulder flexed and the elbow extended. Radiographs may demonstrate mineralization of the tendon, periarticular osteophytes, and/or sclerosis of the intertubercular groove. Arthroscopy is a valuable tool aiding in diagnosis. Supraspinatus tendinopathy is an underdiagnosed problem that is frequently misdiagnosed as biceps tenosynovitis. Supraspinatus tendon inflammation is frequently noted in large breed and sporting dogs. The injury frequently occurs bilaterally, although one leg is significantly more painful than the other. Injury is caused by chronic repetitive strain or trauma. Diagnosis is based on pain on palpation and manipulation of the shoulder and muscle atrophy. Radiographs and ultrasound may demonstrate mineralization of the tendon of insertion on the humerus. Secondary biceps tenosynovitis is commonly seen concurrently. Iliopsoas injury is a rupture or strain injury of the tendon of insertion on the lesser trochanter of the femur. Mineralization may be noted, but more often radiographic changes are not present. Ultrasound of the tendon is valuable in demonstrating disruption or injury to the tendon. Simultaneous extension and internal rotation of the hip joint with palpation of the medial aspect of the proximal femur will demonstrate pain in patients with this injury. Calcanean tendon disruption is easily diagnosed by palpation of thickening of the calcanean tendon where 2 of the 3 tendons insert at the proximal calcaneus (tuber calcanei). With the patient in lateral recumbency and both the stifle and tarsus held in 90 degrees of flexion, laxity in the calcanean tendon may be noted when a partial or complete disruption is present. Patients typically present with a plantigrade stance of the affected leg. Infraspinatus contracture is most commonly seen in hunting and working dogs and is frequently due to acute trauma. Lameness is usually acute, and a characteristic gait abnormality typified by a circumduction of the limb develops within a few days. Atrophy of the infraspinatus muscle is noted and pain on extension of the shoulder with muscle tightness is often observed. Radiographs are usually normal, and ultrasound may be helpful in diagnosis. Treatment of muscle and tendon injuries depends on the muscle injured. Treatment for biceps tenosynovitis involves strict activity restrictions and NSAID’s. When medical management is not helping, biceps tenodesis surgery may be indicated. For supraspinatus tendinopathy strict rest, NSAID’s, and PRP/stem cell injections have shown positive results. Iliopsoas injury usually responds to restricted activity, NSAID’s and light physical therapy.
PRP injections of the iliopsoas has also demonstrated efficacy. Calcanean tendon injuries require surgery to repair the ruptured tendon(s) followed by immobilization in a cast and restrictions for 2-3 months. Infraspinatus contracture responds favorably to transection of the contracted tendon with good return to normal activity in a short time. For any injury to muscle or tendon, the most important aspect of therapy is strict activity restrictions for an extended period of time. Damaged tendons generally heal slowly and in the case of calcanean tendon ruptures, only return to 80% of their original tensile strength at best (this may take up to 1 year to fully heal to this point). Exercise restrictions are most important to allow tendons to re-orient their fibers upon healing to prevent scar tissue formation. Scar tissue decreases the functional ability of the muscle to produce tension by up to 50% making the tendon functionally shortened. Accurate apposition and alignment of a sutured tendon is important to minimize scar tissue formation. Premature mobilization of the tendon before it heals also promotes scar tissue formation. At the same time, prolonged immobilization of a muscle also decreases tensile strength and may result in scar tissue formation. Controlled activity and physical therapy are valuable tools for finding the balance between allowing the tendon to heal while minimizing scar tissue formation. The focus of physical therapy should be on endurance activities such as slow, short, controlled leash walking and low impact activities such as swimming. Strength training activities should be avoided until the muscle is fully healed. Progressively longer leash walks to rebuild strength is the best way to transition a recovering patient back to activity before unrestricted activity resumes. Other modalities such as laser therapy, therapeutic ultrasound, underwater treadmill walking, etc. may be employed under the guidance of a trained rehabilitation specialist. Muscle massage, cryo- and thermotherapy, and range of motion exercises are easily taught to pet owners but must be demonstrated correctly for owners to avoid further muscle injuries while gaining maximal benefits.
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TECH TIPS WITH VETGIRL COO, DR. GARRET PACHTINGER, VMD, DACVECC
Isn’t it frustrating when you find a website you love and want to visit again… but you can’t remember the name? That’s what browser bookmarks were made for. Similarly, the VETgirl team knows the frustration of not remembering where amazing content is and strives to improve the CE experience every day! Well… this newsletter we wanted to highlight our version of the browser bookmark, the VETgirl “Favorite” button.
Simply, “favoriting” allows you to add or save content to your personal list of favorites. This enables quick access to a central area of your account where users can review all content they have favorited to easily review at any time!
Clicking on the heart will convert the outlined image to a red-filled heart image, activating the favoriting feature.
All content that has been “favorited” will appear on your favorites page. When you are done reviewing that content and no longer need to save it on your favorites page, click on the heart again to deactivate the favorites selection (returning the heart to its original, clear icon) which will then remove the page from your favorites grouping.
Thank you again for being part of the VETgirl CE experience, learning with the #1 CE community, resource, and CE management system for busy veterinary professionals.
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TRAINING THAT’S READY WHEN YOU ARE. VETgirl delivers RACE-approved, online veterinary training straight to your device through podcasts, webinars, blogs, videos, and social media.
Get 100+ hours of clinically relevant, practical, cutting edge CE from board- certified specialists on your time.
• Small animal • Large animal
• Technician • Leadership
Find the plan that is right for you.
As on-the-floor clinicians, we know what you need to practice better medicine, provide better patient care, and ultimately save that patient’s life. VETgirl certification is designed to give you the expertise that you need, geared for clinical veterinary professionals. Offered in unique tracks, these courses range from 12-60 hours of RACE-Approved CE for veterinary professionals. certification program certification program
ADVANCED certification program
anesthesia & analgesia emergency medicine
Learn all you need to know about analgesia and anesthesia, so you can master how to safely anesthetize your patients! Course Outline : 30 hours
BASIC emergency medicine certification program
ophthalmology Brush up on your emergency medicine to become a more confident, prepared, and knowledgeable
emergency veterinarian. Course Outline : 35 hours ADVANCED emergency medicine anesthesia & analgesia emergency medicin veterinary nutrition em rgency medicine ADVANCED ADVANCED
certification program certification program
anesthesia & analgesia
You’ve been doing ER for years. Take it to the next level in this carefully curated advanced emergency critical care course. Course Outline : 60 hours BASIC
ophthalmology certification program certification program certification program
ophthalmology BASIC emergency medicine emergency medicine BASIC
practice management If eye cases make you see red, check out our amazing VETgirl ophthalmology lectures to help improve your ophtho skills! Course Outline : 30 hours emergency medicine
anesthesia & analgesia anesthesia & analgesia anesthesia & analgesia
veterinary nutrition veterinary nutrition
veterinary nutrition Thanks to generous support from Hill’s Pet Nutrition, g t the 411 on what’s new in veterinary nutrition, from life-stage nutrition to urolith management. Course Outline : 12 hours
practice management practice management practice management Improve your business and leadership skills to make your veterinary clinic run lean, efficiently and smoothly. Course Outline : 30 hours
ophthalmology ophthalmology ophthalmology
Visit vetgirlontherun.com/certificates/ for more information on course offerings and certification details! * Note: The basic emergency medicine certificate should be completed prior to the advanced course. The VETgirl Practice Management certificate has also been approved by the Certified Veterinary Practice Manager Board as applicable toward the continuing education requirement for the Certified Veterinary Practice Manager (CVPM) program offered by the Veterinary Hospital Managers Association (VHMA), CVPM Course Approval ID# 21-25.
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MARIE BUCKO , DVM Head of Student Ambassador Program, VETgirl
Dr. Marie Bucko recently joined VETgirl as the Head of the VETgirl Student Ambassador Program. Marie is a 2021 graduate of the University of Wisconsin-Madison College of Veterinary Medicine and former Student American Veterinary Medical Association (SAVMA) president, focused on making veterinary school a better experience for all. Marie Bucko has spent her life using her personal and career experiences to help advocate for farmers. As a highly motivated public servant and veterinarian, she has a passion for working at the intersection of animal health, public health, public policy and communicating science. She serves as the Science & Technology Advisor for the National Pork Producers Council in Washington DC. Before becoming a veterinarian, Marie served the US Food and Drug Administration’s Food and Veterinary Medicine (FVM) Program as a Science Policy Analyst in DC. She helped in developing performance metrics for the Food Safety Modernization Act and Veterinary Feed Directive. She served as the point person for the agency’s Center for Veterinary Medicine helping to prepare agency leadership for Congressional briefings, leading FVM’s Congressional Appropriation’s response efforts, coordinating industry meetings, and leading the National Antibiotic Resistance Monitoring System communications across USDA, CDC, & FDA. During this time, she received her Masters of Science in Food Safety from Michigan State’s College of Veterinary Medicine. Marie grew up on a beef and sheep farm in a small town in south-central Wisconsin. She is an avid cooker/baker, anything outdoors, going on veterinary mission trips, supporting FFA & 4-H members, and eating too much Nutella. She loves spending time with her husband and two fur- children who reside in Madison, WI.
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UPCOMING WEBINARS now including large animal, leadership and more training
VETGIRL BLOG unique topics in quick-read format
PODCASTS CE training on the run
© VETgirl 2021. VETgirl is an approved provider of online veterinary continuing education by the AAVSB (Provider #785). Each program is reviewed and approved (or pending approval). This approval is valid in jurisdictions which recognize AAVSB RACE; however, participants are responsible for ascertaining each board’s CE requirements. Participants should be aware that some boards have limitations on the number of hours accepted in certain categories and/or restrictions on certain methods of delivery of CE. Please contact the AAVSB RACE program or VETgirl if you have any comments/concerns.
NOTE: When in doubt, all drug dosages should be confirmed and cross-referenced with a reference guide such as Plumb’s Veterinary Drug Handbook.
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Thank you for being a part of the #1 online CE resource for busy veterinary professionals.
VETgirl Beat Issue 10 | July 2021
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