vet tech animals

Advice #2

If you own a pet that is on a medication that significantly improves your pets state of life or is actually life threatening to not be on, do not wait until you are down to one or two doses to call in a refill. Do not wait until you are out of your medication to call in a refill. DO NOT WAIT. Many medications often come from compounding pharmacies that are out of state and can take up to a week to refill. If your pet has not been seen or had blood work done within a year it is illegal to prescribe most drugs to your pet. We are not being difficult-we are simply following the law so we don’t lose our pharmacy license. YOUR POOR PLANNING DOES NOT CONSTITUTE AN EMERGENCY. So please ask questions, please plan ahead, please learn what happens if your pet is to run out of your their medication so you understand the consequences of your actions.

9

Think it’s cute when your kitty plays with your hair ties? Bats them around, chews on them, she just looks so happy.

Looks at this and reconsider what you find cute. Slightly graphic photo to follow.

26 hair ties. This is what it looks like when your cat eats 26 hair ties.

And this case isn’t even worst case scenario. This cat made it just fine about a month or so. Because all of the hair ties stayed in the stomach, and small amounts of food were still able to pass around them, she kept going mostly ok. But she was very painful and dehydrated. Worst case scenario would be a complete blockage or intussusception (telescoping of the intestines) which can lead to tissue death and eventual death of your pet. And if it doesn’t cost your pet’s life and well being, it could cost you between $1,000-$3,000. Maybe even more at certain hospitals.

Please make sure that the toys you give your pets are safe. My number one rule is, if you think your pet could swallow the toy hole, or chew it up and swallow it, it’s a no go. If need be, ask your vet for advice on toys. 

2

THROMBOCYTOPENIA

Thrombocytopenia is characterised by a low platelet count within the blood. Platelets are manufactured within the Bone Marrow are essential for maintaining haemostasis or in more simpler terms the bodies ability to clot and protect itself from haemorrhage. Thrombocytopenia can be a life threatening condition if not addressed.

WHAT CAUSES THROMBOCYTOPENIA?

 There is no breed, age or sex prevalence concerning this condition. There are five main types of cause:

1) Decreased production of platelets -  This can be caused by types of medication such as oestrogen meds or chloramphenicol. However, the most common cause is aplastic anaemia which occurs when there is a failure in the bone marrow or when the patient is suffering from Leukaemia. Cancer patients undergoing chemotherapy and radiation can also suffer from this type of thrombocytopenia. 

2) Increased blood clotting - Increased blood clotting can be caused by several conditions such as Disseminated Intravascular Coagulation where blood clots form in small blood vessels resulting in poor tissue perfusion and ultimately organ damage. Endotoxic shock can also cause this as well and vasculitis and certain types of cancer i.e Haemangiosarcoma.

3) Destruction of platelets - This is usually caused by autoimmune disease, where the bodies own immune system attacks and destroys its own platelets.This type of condition is more common in dogs and rarely seen in cats. Platelets can also be prematurely destroyed if the patient is suffering from diseases such as Ehrlichiosis and Babesiosis caused by infected tick bites and Heartworm. 

4) Sequestration (The removal of platelets from circulation) - Splenomegaly or a splenic torsion can cause the spleen to function abnormally and in some cases collect and retain up to 90% of the total platelet volume.

5) Haemorrhage due to trauma

WHAT ARE THE CLINICAL SIGNS?

  • Pyrexia
  • Lethargy and appetite loss
  • Heart Murmur
  • Haematuria
  • Excessive coughing
  • Epistaxsis
  • Collapse
  • Petechiae - pinpoint haemorrhages usually seen on the mucus membranes
  • Bruising easily
  • Melena or fresh blood in stools

HOW DO YOU DIAGNOSE THROMBOCYTOPENIA?

Taking a full clinical history to rule out a recent trauma is important as they will enable the clinician to rule out internal haemorrhage due to trauma, in addition information can be gathered to access whether the patient could be suffering from any infectious disease or have contracted any disease such as Babesiosis.Full blood analysis to include biochemistry, haematology and coagulation times should be carried out, in addition to this a 4DX profile testing for 6 vector-bourne diseases is recommended. Radiographs and Abdominal ultrasound can rule our internal haemorrhage and allow for a cancer screen. Additionally a bone marrow aspirate can be carried out. 

WHAT TREATMENT IS AVAILABLE?

In severe cases a blood transfusion is recommended, however in the UK the only source of platelets is from a whole blood transfusion. This must be carried out within four hours of collection and only when the platelet count is very low and bleeding into areas such as the respiratory system is evident. This is a salvage procedure and unfortunately very rarely makes a difference in severely thrombocytopenia patients due to the lack of active platelets in one unit of whole blood. 

In patients suffering from immune mediated thrombocytopenia, steroids or other immunosuppressing drugs are used and often these can successfully control the condition, although relapses are common. 

NURSING CONSIDERATIONS

  • Careful handling and minimal restraint
  • No neck leads to prevent pulling and avoidable bruising around the neck
  • No jugular/arterial blood sampling to prevent haemorrhage
  • Padded kennel again to prevent bruising from laying on hard floor
3

EXTRAHEPATIC BILIARY TRACT OBSTRUCTION (EHBO)

What is EHBO?

In both dogs and cats Bile is produced in the Liver, it is secreted from the  Bile Canaliculi (small ducts within the Liver) into larger ducts before it then enters the  Bile duct and comes to be stored in the Gallbladder. From here the Bile drains through the Common Bile Duct which then empties into the Duodenum (The first part of the Small Intestine). 

EHBO is the blockage of normal Bile flow from the Liver to the Intestinal Tract.

What causes EHBO?

  1. Pancreatitis 
  2. Edema from perioperative handling of the Pancreas
  3. Gallstones
  4. Pancreatic, Bile Duct and Intestinal Neoplasia

What are the clinical signs of EHBO?

Clinical symptoms of EHBO are often nonspecific and can be the same as other abdominal conditions, in addition the signs can wax and wane and therefore patients are often not presented to a vet until icterus develops.

  • Decreased Appetite
  • Vomiting
  • Diahorrea
  • Lethargy
  • Pyrexia
  • Abdominal Pain
  • Dehydration
  • Icterus i.e Jaundice (Yellow discolouration to the mucus membranes, skins and sclera) usually present within 24hrs. 

How is EHBO diagnosed?

Blood Work - When the Bile Duct is obstructed serum levels of Bilirubin will be increased, and due to this the Liver enzymes (ALT & ALP) will also be increased. In severe cases the kidney values (UREA & CREA) will also be elevated and clotting times prolonged.

Radiographs - Useful in identifying stones within the biliary system and other abdominal disorders that could be contributing to the EHBO.  

Ultrasound - Abdominal ultrasound is a recommended diagnostic technique in all cases when the patient is suspected of either bile duct obstruction or disease of the Gallbladder.

How is EHBO treated?

The main aim = Confirm diagnosis, establish a patent biliary system and minimise post-operative complications. 

EHBO is almost always treated by surgical intervention which involves either removing the obstruction or bypassing it completely. Biliary-enteric anastomoses (cholecystoenterostomy) or rerouting bile from the Gallbladder to the Small Intestine will establish patency of the bile duct and help resolve clinical symptoms. 

What is the prognosis?

To ensure the outcome is positive early detection and quick resolution is needed as other metabolic issues can arise the longer a obstruction is present. Survival rates following surgery can be anywhere from 40-70%. 

2

VESTIBULAR DISEASE

The Vestibular organs, found in the inner ear serve to provide the brain with information about the body’s position with respect to gravity, alerting the brain if the patient is upside down, turning, falling or upright. It also co-oridinates sensory information such as vision and proprioception to ensure the pet stays balanced and can see clearly while moving.

Vestibular dysfunction can be associated with either the peripheral system (the inner ear) or the central nervous system (the brain). When it occurs in cats and dogs the problem is usually with the inner ear. This information is related to peripheral dysfunction.

Causes

Peripheral dysfunction is usually idiopathic and is more common in old dogs hence its alternative name ‘old dog vestibular syndrome’. But can be caused by less common conditions such as middle ear infections, ototoxicity and head trauma.

Clinical Signs

  • Spinning/Walking in circle continuously
  • Exaggerated Stance 
  • Head Tilt
  • Falling or Rolling to one side
  • Nystagmus
  • Squint
  • Ataxia
  • Head Shaking
  • Vomiting
  • Refusal to eat and drink

Diagnosis 

The condition is usually assumed by assessing the clinical signs evident during a clinical examination. However if money is no object full haematology and biochemistry blood analysis should be carried out, where possible thyroid level testing should be undertaken. Otoscopic exam of the ear is recommended to look for infection and urinalysis can be helpful.

Treatment

As the cause is often idiopathic, treatment is often symptomatic. Anti-emetics can be given to stop vomiting and reduce nausea, intravenous fluids are recommended for patients which aren’t eating and drinking to ensure they are supported in terms of hydration and nutritional needs. As ataxia can be severe, causing patients to become disorientated and stress, sedatives may be required. If a inner ear infection is suspected antibiotics are needed.

Prognosis

The clinical signs are often worse for the first 24-48hours. Initial improvement can take up to 72 hours, however the head tilt can last for 2-3 weeks. If the condition worsens or fails to improve a more serious underlying condition should be assumed.