Patient Injury & Complications In Veterinary Dentistry
The nature of anesthesia brings risk in general. In veterinary medicine, during dental procedures, pets are often placed in vulnerable positions which can lead to increased risk of injury and medical complications.
These risks can be minimized or entirely avoided with careful consideration, and proper training and continuing education of staff. Listed are a few of the more common injuries that can occur during a dental procedure.
Aspiration Pneumonia
Aspiration pneumonia in pet patients occurs when the patient inhales a foreign substance and develops lung inflammation and infection as a result.
The most common occurrence during dentistry is water and debris entering an unprotected airway, hence allowing fluid and debris to enter the lungs. This can occur from an underinflated tracheal tube, or repositioning during the procedure that allows fluid to enter the airway.
Aspiration pneumonia can also occur if the patient vomits or regurgitates during anesthetic recovery.. To reduce the incidence of dental-related aspiration pneumonia, maintaining the patient on their back during the procedure, and avoiding repositioning has proven to not only lessen the risk of aspiration but also lessens the amount of anesthesia needed during the procedure.
In addition, antiemetic medications given during the premedication phase can help reduce the incidence of post-anesthetic nausea and vomiting. Caution should be taken during the recovery phase to wait until the patient is alert and responsive enough to deflate the cuff and remove the tracheal tube.
Tracheal rupture
Tracheal rupture in dogs and cats are more frequent during dental procedures than any other medical procedure. Seventy-five percent of tracheal ruptures are thought to be associated with oral surgical procedures with the incidence more common in cats than dogs.
Tracheal injury can cause symptoms such as mild dyspnea, and even death. The most likely cause of tracheal rupture is thought to be due to an overinflated tracheal cuff, as well as failing to detach the tracheal tube from the anesthesia hose during repositioning, which can cause a torque on the inflated cuff resulting in a tear of the dorsal membrane of the trachea.
Another common cause of tracheal rupture is a patient that is not adequately anesthetized and coughs or lunges upward during intubation, tearing the trachea.
Pressure from an overinflated cuff can cause pressure necrosis of the trachea, showing delayed symptoms of inflammation and scarring.
Avoiding over-inflation of the cuff, using new tracheal tubes, testing the cuff to ensure proper inflation prior to use, avoiding repositioning as much as possible, and ensuring a level plane of anesthesia prior to intubation can help minimize the risk of tracheal rupture.
Artery Damage during Tooth Extractions
Arterial damage to arteries such as the palatine artery which runs the length of the mandible can accidentally occur during routine tooth extractions where the instrument can slip from the practitioner’s hand.
These injuries can be mild to more severe requiring surgical intervention.
The most effective way to avoid this type of injury is to implement extraction techniques involving gingival flaps where the roots are exposed, and more easily undermined, and extracted.
Written by: Dr. Tammy Powell, DVM
Mastering FORLs: X-Ray Insights for Better Dental Procedures
To extract or not to extract that tooth root?
Is a crown amputation all that’s needed?
When it comes to feline odontoclastic resorptive lesions (FORLs), these may be the questions you’re asking yourself.
FORLs can cause loss of the protective surfaces (enamel, cementum, and dentin) of both the crown and the root(s) of a tooth, resulting in pain.
These lesions come in two varieties:
Type 1: Where the root appears radiographically normal.
Type 2: Where the root is radiographically hard to distinguish from the surrounding bone, with loss of visibility of the periodontal ligament space.
As you know, the treatment for these lesions is different—full extraction of the root(s) for Type 1, versus just a crown amputation for Type 2.
Performing a crown amputation and leaving a root in place for Type 1 could result in problems or complications, not to mention continued pain for the patient.
On the other hand, trying to extract the root of a true Type 2 lesion could be a monumental task and a big headache.
So, it’s very important to determine what type of lesion you’re dealing with. Here’s how…
Diagnosing FORLs
Patient presentation:
A client brings their pet to you because of halitosis, food dropping, and occasional jaw chattering.
During the physical exam, you notice bright red, inflamed gums and gingival hyperplasia near one of the mandibular premolars.
You suspect a FORL—and given that FORLs are one of the most common dental problems in cats, you’re probably right.
You suggest a dental procedure, including dental radiographs, a full cleaning, oral exam, and possible extraction. The client agrees with the plan.
The day of the procedure
After the patient is anesthetized, your technician obtains radiographic images of the entire mouth, which takes just a few minutes to perform.
Then, you look at the radiographs in conjunction with your oral exam.
While probing the tooth in question, you feel a rough patch under the gingival hyperplasia, consistent with a resorptive lesion.
The x-ray confirms your diagnosis.
Determining the best treatment plan
In this case, the patient’s tooth is clearly Type 1, with a periodontal ligament space still visible. So, you perform a full extraction.
While evaluating the dental rads, you also notice the premolar on the opposite side is starting to show radiographic evidence of a lesion.
Even though it’s mild, you call the owner and inform them of the likelihood of progression.
To prevent a painful lesion from developing between dentals, the owner decides to go forward with a pre-emptive extraction of that tooth as well.
Documenting the extraction
In addition to being an integral part of your treatment plan decisions, dental radiographs can also help you document that extraction was performed successfully.
A post-procedure x-ray image is a great way to document that there are no root tips left behind.
And, in cases where a crown amputation was indicated, dental rads provide visual proof that this was an appropriate treatment course.
In this way, dental radiographs not only help you to plan and implement a very high quality of medicine—but they also give you peace of mind and are a valuable part of your medical records.
Talking to clients about dental radiographs
Maybe you already know the benefits of dental radiography—but you’re concerned about discussing the additional cost with clients.
Often, it helps to include the x-rays as part of the dental procedure package. List them on the estimate so the client understands the value they are receiving—just don’t itemize the cost of the radiographs separately.
Be sure to adjust the estimate of the dental package accordingly, to cover your costs. And remember, with a monthly payment plan for your dental radiography system, just a couple of dental procedures per month can cover your investment.
Client education also helps. Explain how the results of the radiographs allow you to provide the best possible treatment and reduce the likelihood of future complications.
With clients who want the best for their pets, it’s a win-win for both of you.
Written by: Dr. Tammy Powell, DVM
How to Explain Halitosis Risks to Concerned Pet Owners
Bad breath, or halitosis, is one of those health problems that’s easy for pet parents to overlook.
Sure, it’s inconvenient. Stinky breath can certainly put a damper on a pet owner’s cuddle time or other interactions with their dog or cat.
However, many pet owners don’t realize that halitosis can mean something much worse… such as periodontal disease, or even an internal problem.
As a veterinarian, you know this very well—but it can be a challenge to communicate the dangers lying “under the surface” when it comes to bad breath.
Explaining halitosis to pet parents
The first step is figuring out where the bad breath is coming from, and explaining the potential risks to clients.
Dental problems such as periodontal disease are the most common cause of bad breath in pets.
But sometimes, halitosis begins somewhere in the body other than the mouth.
Possible sources of halitosis include…
Periodontal disease and other dental issues.
A health condition such as kidney disease (an ammonia-like or unpleasant smell) or diabetic ketoacidosis (more of a sweet smell).
Respiratory diseases.
Digestive issues or dietary indiscretions.
Objects (like branches or chicken bones) stuck somewhere in the mouth.
Oral neoplasias.
Certain toxins.
Based on your patient’s history and physical exam, you’ll determine the most likely cause of the bad breath and decide if diagnostic testing is needed.
If the patient in front of you seems otherwise healthy but has apparent terrible dental disease, you can probably assume the smell (or at least, a large portion of the scent) is coming directly from their mouth.
If a dental procedure is indicated, you’ll likely do pre-op bloodwork, which will help confirm that the patient is otherwise healthy.
A recap of periodontal disease
It all starts with plaque, that thin film that forms on teeth due to food and saliva. We get plaque as humans, too, but fortunately, plaque can be removed by tooth brushing.
If not brushed away, plaque hardens into calculus (tartar) within as little as 24-36 hours. Then, it accumulates more and more over time and harbors bacteria. Calculus can’t be removed by toothbrushing alone.
Soon, this calculus (and its resident bacteria) become very irritating to the gums—and they like to grow below the gum line, where it’s harder to observe the process visually. This results in gingivitis, an early stage of periodontal disease (a disease process affecting the structures that hold teeth in place) where the gums become red and inflamed and may bleed.
From here, as the periodontal disease worsens, it creates pockets in the gumline, destruction of the periodontal ligament, and even bone loss in the maxilla and mandible. In severe cases, this bone loss can cause jaw fractures.
This all leads to pain and tooth loss. And, opportunistic bacteria may enter the bloodstream via inflamed gums, traveling to and causing problems in organs such as the heart or kidneys.
Reminding clients of the dangers of periodontal disease can help them understand their pet’s bad breath is true health and quality of life problem—not just an inconvenience.
Evaluating and treating dental and periodontal disease
Your initial pre-op exam will be done while the patient is awake—ideally with the owner present so you can show them what you’re seeing.
However, awake exams don’t allow for a full oral assessment. And, dogs or cats who are painful might not let you get a good look.
So you’ll make a dental cleaning estimate based on your initial exam but explain to the client that the full assessment will be done during the procedure.
This assessment should include dental radiographs. Since much of the disease process starts below the gumline, x-rays are the only way to see the full extent of damage from periodontal disease.
Some patients will just need routine cleaning, while others may need significant dental extractions. And, you can talk to your clients about continuing dental care at home through tooth brushing and dental treats.
By providing this valuable service, you’ll be not only keeping your canine and feline patients in great health—but also increasing the human-animal bond by preventing halitosis from interfering with the quality time between a pet and their owner.
Disclaimer: This article is for general informational purposes only, and not intended as a guide to the medical treatment of any specific animal.
Written by: Dr. Tammy Powell, DVM
Good Exam Room and Dental Lighting: Why It Matters
When it comes to upgrading your veterinary practice, maybe the first things that come to mind are new exam tables, high-tech anesthesia monitoring equipment, or an in-house chemistry analyzer.
Was a new LED exam room light also on your list? If not, it should be. Here’s why…
While lighting is often overlooked, just think about how many times per day a good, strong light could make your life easier.
Times, when a high-quality LED light could come in handy in your exam room, include the evaluation of…
Lesions and wounds.
Dental disease or oral lesions.
Ocular health (you’ll use your ophthalmoscope and other equipment for a more detailed exam, but good room lighting can help you pick up subtle lesions during a routine checkup).
Paw pads and the spaces between the paw pads.
External ear structures.
Dander, fleas, and other skin and coat issues.
These are a few good examples—but really, good lighting can help with much of the physical exam by making it easier for you to accurately document tissue colors, textures, lesions, and other notable abnormalities in your medical record.
Good lighting is essential for dental procedures and surgeries
In our last blog post, we gave some advice on how to pick a good surgical light.
And along those same lines, don’t forget about dental procedures!
The mouth is like a dark cave, making it difficult for you and your staff to see what you’re working on if you don’t have good lighting.
Some things a good light will help you visualize include…
Calculus that needs to be cleaned—and verifying that all calculus was removed.
Enamel defects and small chips or fractures.
Staining, or other color changes such as pulpitis.
Subtle bleeding or mild gingivitis.
Oral abnormalities such as masses or inflammation.
Pharyngeal or tonsillar abnormalities.
Extraction sites—before, during, and after the extraction.
Placement and manipulation of small sutures.
Not to mention, a good overhead light can aid your laryngoscope light during intubation.
How affordable are good LED lights?
In the past, LED lights were very expensive compared to halogen bulbs—so it’s understandable if you’ve not purchased one before.
However, some brands are now 30-40% less than previous LED prices.
So, LEDs don’t have to be expensive anymore. And considering their performance and efficiency, a good LED light can be a great addition to your practice.
Plus, many cities, counties, states, and even electric power companies offer rebates for upgrading to LED lights, due to the decrease in power used.
Specific requirements for rebates vary by location—so be sure to check with your local municipality and utility providers to see what’s available in your area. Because it’s always great to get a cash rebate that can help cover the cost of your upgrades!
How do you choose a good exam room or dental light?
When it comes to selecting the best lighting, there are many things to consider…
Affordability. LED lights are much more affordable now than they used to be, so shop around and be sure you’re getting a good deal (to be sure you’re comparing apples to apples, check for the other factors on this list, too).
Quality and dependability. Plus, a good-value warranty helps to back up your investment.
Lighting adjustability in terms of intensity and dimming options, as well as area of focus.
Precise positioning. The light head and arm should be easy to move and manipulate—but then, stay right where you put it without drifting.
Easy to clean.
User-friendly, with simple controls on or near the handle.
Shadow-free illumination—or at least a design that minimizes shadows as much as possible.
Mounting options that match the layout of your rooms.
Comfortable and safe for pets, with adjustable settings you can change as needed, and low heat output.
Here’s what we recommend…
We recommend the new Burton veterinary LED exam light because it checks all the boxes listed above.
Plus, it has a high-quality LED (virtually heat-free and with a 75% energy savings compared to halogen), is assembled in the USA, and is backed by an industry-leading 5-year warranty.
At a competitive price point that optimizes design, performance, and value, it’s pretty hard to pass up!
Why invest in new lighting?
As we said, lighting is often overlooked in terms of equipment upgrades…
But, just think of how many times per day you’ll use a good-quality light in your exam rooms or dental area.
In terms of cost per use, that can make new lighting a great investment—something you’ll benefit from using many times per day.
And if your new light makes your life easier in terms of visualizing the patient and making accurate medical notes… that’s an investment that could save you time and headaches, and be well worth it!
Vomiting in Cats: Common Causes and Diagnostic Steps
Cats are good at hiding illness and pain. So, for some feline patients, it’s hard to tell what’s behind a bout of vomiting.
A few of the many possible causes include:
Hairballs.
Food sensitivities.
Dietary indiscretion.
Infections or parasites.
Stress.
Pain.
GI foreign bodies.
Inflammatory conditions.
Internal issues such as kidney disease or hyperthyroidism.
Cancer.
Is it serious?
Often, it’s obvious whether the patient needs aggressive treatment right away or just needs a little bit of supportive care and observation at home.
However, other times it’s more difficult to know for sure. Those are the cases that may stay on your mind, making you wonder if the vomiting will continue or even become more severe.
It’s especially nerve-wracking if the patient went home for observation, but you’re concerned they may get worse overnight.
Reaching a diagnosis
Depending on the patient’s signalment, history, and physical exam findings, you’ll recommend the appropriate diagnostic tests.
Bloodwork
Bloodwork is a key factor in determining overall health status, and in establishing a baseline to monitor the patient for improvement or worsening of their condition.
These labs may be especially valuable in senior cats who have lost weight, when kidney disease, hyperthyroidism, or other internal medicine issues may be what comes to mind as the most likely diagnosis.
Imaging with x-rays and ultrasound
For some patients—especially if the vomiting is severe, or if you feel something abnormal on abdominal palpation—imaging may be needed right away. For patients with milder signs, you may decide to hold off on imaging at the first visit, but recommend the client bring their cat back if symptoms don’t improve.
And even if an obvious abnormality is noted on bloodwork (such as elevated thyroid hormone), imaging is still a good idea to rule out concurrent conditions, and to establish a baseline to compare any changes that show up on future imaging tests.
Either way, when it comes to imaging, radiographs are a good place to start.
Radiographs give you a good overview of what’s going on inside the abdomen. You can look for masses, abnormal-looking organs, constipation, bladder issues, pyometra, signs of a GI obstruction, and much more.
However, sometimes more information is needed. Often, x-rays and ultrasound work well together to give you the full picture.
Ultrasound gives you additional clues about soft tissue structures, including:
Differentiating a mass (size, what the borders look like, texture, thickness, etc.) from surrounding normal soft tissues. Silhouetting may make this interpretation challenging on x-ray images.
Viewing bladder stones that aren’t radiopaque.
Looking at small structures that are hard to see on x-rays, such as the adrenal glands.
Inflammation of the GI tract or other internal organs.
Finding evidence of a GI obstruction when it’s not obvious on radiographs (or, ruling out an obstruction—which may help you worry less if you decide to send the patient home for monitoring).
The list goes on, but the point is, x-rays and ultrasound can complement each other to give you the information you need, which can help you confidently diagnosis the mysterious vomiting cat.
Additional tests
Sometimes additional tests—for example, biopsies and infectious disease testing—may be needed to reach a diagnosis.
However, bloodwork, x-rays, and ultrasound are a great place to start. And often, these modalities will need to be completed prior to other modalities such as surgically obtained biopsies.
Lifestyle changes and monitoring
If the vomiting is due to a factor such as stress or hairballs, this may require a simple lifestyle change like providing Feliway diffusers and adding mental enrichment at home, or changing to a special diet.
But even in these cases, it’s good to rule out other, treatable medical causes—so a medical workup with diagnostic tests may still be recommended.
Keeping the vomiting at bay
If you have a patient with a chronic condition, you may recommend repeating the bloodwork, x-rays, and ultrasound at regular intervals.
A wellness checkup package that includes testing may be a good option for many patients—especially seniors. The wellness tests can be offered at checkups before the patient ever becomes ill, which gives you a great baseline for comparison with future test results.
Even though cats may not like to show symptoms of illness until a disease has progressed, wellness bloodwork and imaging (x-rays and ultrasound) can help to catch abnormalities early on, when the chances for treatment are better.
Disclaimer: This article is for general informational purposes only, and not intended as a guide to the medical treatment of any specific animal.
Written by: Dr. Tammy Powell, DVM
Autoclave Sterilization: A Necessity in Veterinary Medicine
In 2021, you’ve probably thought more about sterilization and disinfection than you ever have before.
Of course, you’ve always practiced safely and hygienically. But, this year’s pandemic brought the need for drastic measures like curbside service, face masks during everyday interactions, and washing your hands even more frequently…
… and, you and your staff probably feel like you’re cleaning, cleaning, cleaning all day long!
Best practices for cleaning surfaces and equipment
According to many experts, the best way to avoid viral exposure is the elimination of the risk.
This is where isolation and social distancing protocols come in. Your distancing measures of curbside service, telemedicine, and a limited number of people inside your hospital can all help.
Social distancing within the practice and avoiding the sharing of spaces and equipment as much as possible can also help.
Then, there’s PPE to help minimize any potential exposures—as well as your cleaning and disinfection protocols.
You wear gloves and face masks, you wash your hands and use hand sanitizers, and you clean the surfaces and equipment in your practice.
During your cleaning efforts, don’t forget about a powerful piece of sterilization equipment you probably use frequently…
Maximize your use of this key piece of veterinary equipment…
If your own or work at a veterinary practice, there’s a good chance you have at least one autoclave available for use.
Autoclaves use steam under pressure to kill microbes and are one of the most powerful disinfecting tools you have in your arsenal.
Surgical equipment—and beyond!
An autoclave is a tried and true method of sterilization for surgical packs, drapes, and tools.
But, maybe there are a few more items you don’t always think of that could be put into an autoclave for quick, thorough disinfection.
Things your autoclave can be used for include…
Gowns for surgery, isolation, or general use as an extra layer of protection.
Cloth caps.
Cloth face masks.
Surgery light handles.
Nitrile exam gloves or surgical gloves (ideally these would be single-use, but there are procedures described to maximize the lifespan of your PPE during shortages).
Dentistry tools.
Wound care items such as Penrose drains.
Cones/specula for otoscopes.
Pipette tips.
Certain muzzles.
Certain nail clippers.
Biological waste—in case you suspect viral contamination and want to sterilize waste prior to disposal.
There may be other items you can sterilize, too—so get creative!
Just be sure to check the manufacturer’s guidelines before you sterilize a new item—they’ll guide you on what’s safe or not safe to go in your autoclave.
But, once you get into the habit, this will save you time and do a more thorough job of eliminating microbes than most hand cleanings could ever do.
Why invest in a top-of-the-line autoclave?
In modern times, we can’t help but think of an autoclave as a potent killer of coronavirus!
But really, a good autoclave is useful to you all the time, pandemic or no pandemic. It ensures your equipment is properly sterilized from all microbes prior to use.
A good quality autoclave is dependable and makes your life easier via the simplicity of use. Here’s what we recommend you look for…
Several setting options including solid or liquid items, and wrapped or unwrapped items.
The option to choose a preset that suits your needs.
Large water reservoir so you don’t have to refill as often.
A tabletop model with a large chamber capacity so you can fit more items per cycle.
Locking mechanisms for safety.
A strong warranty and excellent customer service.
Our pick is this Full-Size Veterinary Autoclave because it meets all of these criteria, and has an industry-leading 3-year warranty (which includes a loaner autoclave if yours ever needs to be serviced).
How to keep your autoclave healthy
It’s always important to protect your investments by caring for your equipment—and that’s even more true during times when the business may be slower due to social distancing.
Here are a few tips to keep your autoclave in tip-top shape…
Use distilled water, not tap water.
Post guidelines for routine maintenance (otherwise, it’s easy to forget!).
Look for debris when the autoclave is cool, and clean it as needed.
Wipe the trays clean weekly.
Note any water or steam leaks.
Listen for any unusual sounds.
Observe the tape indicator each time, to ensure the autoclave is functioning as it should.
With a little attention and care, your autoclave will stay healthy—and in turn, it can help keep your equipment pathogen-free!
Now YOU Can Choose the Best Veterinary Lighting for Your Surgery Room
When it comes to surgeries, good lighting is crucial.
Without good quality light, it can be hard to see all the details of what you’re working on, whether that’s a spay, a wound repair, and abdominal exploratory, or anything else.
Dim or subpar lighting can make you strain your eyes while trying to place or tie your sutures. And, adequate lighting is important to accurately note the color, texture, and general appearance of tissues for your medical record—that way, nothing gets missed.
Not to mention, good visualization of your field of work keeps you from craning your neck to see better—which can be helpful for your posture and for preventing aches and pains from hunching over.
Maybe you already understand the importance of good surgical lighting—but did you realize how affordable it is?
In the past, LED lights have been very expensive compared to halogen bulbs—and maybe that seemed cost-prohibitive.
However, new lights are available at 30-40% less (and that includes a better warranty, too).
So, considering the energy efficiency and performance of LED lights, there’s really no competition—affordable, high-quality LEDs are a great investment for your practice.
Plus, many cities, counties, states, and even electric power companies offer rebates for upgrading to LED lights, due to the decrease in power used.
Specific requirements for rebates vary by location—so be sure to check with your local municipality and utility providers to see what’s available in your area. Because it’s always great to get a cash rebate that can help cover the cost of your upgrades!
So, how do you choose the right surgical light?
When it comes to selecting the best surgical light, there are many things to consider…
Affordability. LED lights are much more affordable now than they used to be, so shop around and be sure you’re getting a good deal (be sure to compare all the other factors on this list, too).
Quality. Look for dependability, durability, and a good-value warranty to back up your investment.
Range of lighting brightness, including high-intensity light, and dimming options to use as needed.
Adjustable. The light pattern can be adjusted from a smaller, focused pattern, to a larger area of coverage, depending on your needs.
Precision positioning. You should be able to adjust the entire head and arm of the light, and know it will stay precisely where you put it (we recommend limitless arm rotation and a drift-free design that moves easily when you adjust it, but then stays put where you want it).
Easy to clean (and sterilizable handles are a plus).
User-friendly, with dimming and focusing controls on or near the handle.
Shadow-free illumination—or at least a design that minimizes shadows as much as possible.
Mounting options that match the layout of your surgery room or suite.
What’s our recommendation?
We recommend the new Burton veterinary LED surgery light.
Why? Because this light checks all the criteria above. Plus, it has a dependable LED, is assembled in the USA, and is backed by an industry-leading 5-year warranty.
At a competitive price point that optimizes design, performance, and value, it’s pretty hard to pass up!
Is a Burton light right for you?
When it comes to investing in new equipment for your practice, maybe the lighting isn’t always the first thing on your mind…
However, surgical lighting is something you use many times every week—maybe even several times per day, depending on the nature of your practice.
That’s probably more often than you use some of the other equipment in your hospital.
So, be sure not to overlook this crucial piece of equipment. You may be surprised how better lighting can make your time in the surgery suite more comfortable and efficient.
Mastering Detection & Treatment of Urinary Bladder Stones
Unraveling the Diagnostic Challenge: Spotting Hidden Bladder Stones
Introduction:
Embarking on the quest to identify and address urinary bladder stones in our furry companions requires a nuanced approach. This comprehensive guide is designed to navigate the intricacies of detection and treatment, shedding light on the sometimes elusive nature of these mineral-rich intruders.
Recognizing the Telltale Signs: Is It Bladder Stones?"
Is your pet showing signs of distress like blood in their urine, increased urination, or accidents at home? These could be subtle indicators of urinary bladder stones. Explore this section to decipher the signals that may prompt a visit to your veterinary clinic.
The Power of Radiographs: Shedding Light on Uroliths
Radiographs serve as the cornerstone in this diagnostic journey. Learn about capturing essential views of the abdomen and unraveling the mystery of radiopaque stones. Delve into the nuances of stone size and distribution, from sand-like grains to larger formations.
Contrast Studies: Enhancing Visibility for the Elusive Stones
When radiographs fall short, a double-contrast study becomes essential. Discover the benefits of combining positive and negative contrast agents for optimal bladder stone visualization.
Understand the role of anesthesia or sedation in administering contrast agents through a urinary catheter, ensuring patient safety and comfort.
Ultrasound Magic: Illuminating Radiolucent Stones
Explore the wonders of ultrasound in uncovering radiolucent stones that elude traditional radiographs. Dive into the fluid-filled bladder's role in providing contrast for ultrasound waves, enabling the detection of stones and other bladder abnormalities. Delve into ultrasound's capabilities in assessing the upper urinary tract, identifying issues beyond bladder stones.
Tailoring Treatment: From Diet Changes to Cystotomies
Based on diagnostic findings, discover treatment options, from recommending dietary changes for dissolvable stones to performing cystotomies for stone removal. Understand the importance of follow-up imaging to track progress and determine the effectiveness of dissolution.
Post-Op Imaging: Ensuring Success in Stone Removal
Uncover the critical role of imaging on the day of surgery, utilizing pre-op radiographs to confirm stone presence and post-op views to document successful removal. Navigate the choice between standard radiographs and ultrasound for follow-ups, ensuring the long-term health monitoring of the urinary system.
Conclusion:
Armed with a combination of imaging modalities, veterinary professionals can empower clients to proactively address, monitor, and prevent urinary bladder stones in their cherished pets.
Stay ahead in the journey of pet healthcare with crystal-clear insights into the world of diagnosing and treating these pesky intruders.
Your commitment to comprehensive care ensures a happier and healthier life for our four-legged friends.
A Vet's Guide to Safe, Conscious X-Rays for cat Patients
1: Balancing Safety and Conscious Imaging
X-rays serve as invaluable tools in feline diagnostics, offering crucial insights when executed with precision. However, coaxing a cat into a state of stillness for the procedure without resorting to sedation presents a unique challenge. In this guide, we explore the delicate balance between achieving diagnostic-quality X-rays and ensuring the well-being of both feline patients and veterinary staff.
2: When Sedation Isn't an Option: Considerations and Scenarios
Before embarking on the journey of conscious cat X-rays, veterinary professionals must assess the necessity of avoiding sedation. Safety remains the top priority for patients and staff alike, as repeated attempts due to poor positioning or movement can elevate stress levels and radiation exposure.
While short-acting sedation options exist, there are scenarios where a conscious approach is preferable, such as with cats having advanced cardiac disease or previous adverse reactions to sedation.
3: Techniques for Conscious Radiographs: A Step-by-Step Approach
Ensuring a smooth and stress-free process for conscious X-rays involves meticulous preparation and execution. This section provides practical tips for veterinary professionals to enhance the welfare of feline patients and maintain a safe environment during the procedure.
4: Preparing for Success: The Importance of Readiness
To successfully execute conscious X-rays, meticulous preparation is non-negotiable. From predicting kV and mA settings to having restraint equipment readily available, the efficiency of the procedure relies on a well-thought-out plan. Implementing feline-centric protocols, including calming voices, quiet environments, and minimal handling, contributes to a low-stress atmosphere.
5: The Art of Positioning: Tools and Techniques
Positioning a cat for X-rays demands creativity and careful consideration.
This section introduces various tools, such as Perspex boxes, sandbags, troughs, and foam wedges, to aid in achieving optimal positioning without compromising patient comfort. Emphasizing that "less is more" in cat restraint, the guide outlines methods to stabilize cats with respiratory concerns while maintaining minimal restraint.
6: Taking the Shot: Executing the Radiographs
Executing conscious radiographs requires coordination and precision. This section guides veterinary professionals through the process, from staying with the cat until the machine is ready to providing reassurance during the 'beep' or 'click' of the X-ray machine.
Tips for allowing the cat to rest between shots and recognizing signs of distress ensure a humane approach throughout the procedure.
7: Pitfalls and Prudence: Navigating Challenges
While conscious radiographs offer a non-sedative alternative, potential pitfalls exist, such as poor positioning, movement blur, or sub-optimal exposure.
This section emphasizes the preference for sedation or anesthesia whenever possible to achieve radiographs safely, underlining the importance of adaptability and recognizing when chemical restraint may be necessary.
By mastering the art of stress-free cat X-rays, veterinary professionals can enhance the diagnostic process, ensuring the well-being of their feline patients and fostering a positive experience for both cats and their human companions.
Patient Injury & Complications In Veterinary Dentistry
The nature of anesthesia brings risk in general. In veterinary medicine, during dental procedures, pets are often placed in vulnerable positions which can lead to increased risk of injury and medical complications.
These risks can be minimized or entirely avoided with careful consideration, and proper training and continuing education of staff. Listed are a few of the more common injuries that can occur during a dental procedure.
Aspiration Pneumonia
Aspiration pneumonia in pet patients occurs when the patient inhales a foreign substance and develops lung inflammation and infection as a result.
The most common occurrence during dentistry is water and debris entering an unprotected airway, hence allowing fluid and debris to enter the lungs. This can occur from an underinflated tracheal tube, or repositioning during the procedure that allows fluid to enter the airway.
Aspiration pneumonia can also occur if the patient vomits or regurgitates during anesthetic recovery.. To reduce the incidence of dental-related aspiration pneumonia, maintaining the patient on their back during the procedure, and avoiding repositioning has proven to not only lessen the risk of aspiration but also lessens the amount of anesthesia needed during the procedure.
In addition, antiemetic medications given during the premedication phase can help reduce the incidence of post-anesthetic nausea and vomiting. Caution should be taken during the recovery phase to wait until the patient is alert and responsive enough to deflate the cuff and remove the tracheal tube.
Tracheal rupture
Tracheal rupture in dogs and cats are more frequent during dental procedures than any other medical procedure. Seventy-five percent of tracheal ruptures are thought to be associated with oral surgical procedures with the incidence more common in cats than dogs.
Tracheal injury can cause symptoms such as mild dyspnea, and even death. The most likely cause of tracheal rupture is thought to be due to an overinflated tracheal cuff, as well as failing to detach the tracheal tube from the anesthesia hose during repositioning, which can cause a torque on the inflated cuff resulting in a tear of the dorsal membrane of the trachea.
Another common cause of tracheal rupture is a patient that is not adequately anesthetized and coughs or lunges upward during intubation, tearing the trachea.
Pressure from an overinflated cuff can cause pressure necrosis of the trachea, showing delayed symptoms of inflammation and scarring.
Avoiding over-inflation of the cuff, using new tracheal tubes, testing the cuff to ensure proper inflation prior to use, avoiding repositioning as much as possible, and ensuring a level plane of anesthesia prior to intubation can help minimize the risk of tracheal rupture.
Artery Damage during Tooth Extractions
Arterial damage to arteries such as the palatine artery which runs the length of the mandible can accidentally occur during routine tooth extractions where the instrument can slip from the practitioner’s hand.
These injuries can be mild to more severe requiring surgical intervention.
The most effective way to avoid this type of injury is to implement extraction techniques involving gingival flaps where the roots are exposed, and more easily undermined, and extracted.
Written by: Dr. Tammy Powell, DVM
Good Exam Room and Dental Lighting: Why It Matters
When it comes to upgrading your veterinary practice, maybe the first things that come to mind are new exam tables, high-tech anesthesia monitoring equipment, or an in-house chemistry analyzer.
Was a new LED exam room light also on your list? If not, it should be. Here’s why…
While lighting is often overlooked, just think about how many times per day a good, strong light could make your life easier.
Times, when a high-quality LED light could come in handy in your exam room, include the evaluation of…
Lesions and wounds.
Dental disease or oral lesions.
Ocular health (you’ll use your ophthalmoscope and other equipment for a more detailed exam, but good room lighting can help you pick up subtle lesions during a routine checkup).
Paw pads and the spaces between the paw pads.
External ear structures.
Dander, fleas, and other skin and coat issues.
These are a few good examples—but really, good lighting can help with much of the physical exam by making it easier for you to accurately document tissue colors, textures, lesions, and other notable abnormalities in your medical record.
Good lighting is essential for dental procedures and surgeries
In our last blog post, we gave some advice on how to pick a good surgical light.
And along those same lines, don’t forget about dental procedures!
The mouth is like a dark cave, making it difficult for you and your staff to see what you’re working on if you don’t have good lighting.
Some things a good light will help you visualize include…
Calculus that needs to be cleaned—and verifying that all calculus was removed.
Enamel defects and small chips or fractures.
Staining, or other color changes such as pulpitis.
Subtle bleeding or mild gingivitis.
Oral abnormalities such as masses or inflammation.
Pharyngeal or tonsillar abnormalities.
Extraction sites—before, during, and after the extraction.
Placement and manipulation of small sutures.
Not to mention, a good overhead light can aid your laryngoscope light during intubation.
How affordable are good LED lights?
In the past, LED lights were very expensive compared to halogen bulbs—so it’s understandable if you’ve not purchased one before.
However, some brands are now 30-40% less than previous LED prices.
So, LEDs don’t have to be expensive anymore. And considering their performance and efficiency, a good LED light can be a great addition to your practice.
Plus, many cities, counties, states, and even electric power companies offer rebates for upgrading to LED lights, due to the decrease in power used.
Specific requirements for rebates vary by location—so be sure to check with your local municipality and utility providers to see what’s available in your area. Because it’s always great to get a cash rebate that can help cover the cost of your upgrades!
How do you choose a good exam room or dental light?
When it comes to selecting the best lighting, there are many things to consider…
Affordability. LED lights are much more affordable now than they used to be, so shop around and be sure you’re getting a good deal (to be sure you’re comparing apples to apples, check for the other factors on this list, too).
Quality and dependability. Plus, a good-value warranty helps to back up your investment.
Lighting adjustability in terms of intensity and dimming options, as well as area of focus.
Precise positioning. The light head and arm should be easy to move and manipulate—but then, stay right where you put it without drifting.
Easy to clean.
User-friendly, with simple controls on or near the handle.
Shadow-free illumination—or at least a design that minimizes shadows as much as possible.
Mounting options that match the layout of your rooms.
Comfortable and safe for pets, with adjustable settings you can change as needed, and low heat output.
Here’s what we recommend…
We recommend the new Burton veterinary LED exam light because it checks all the boxes listed above.
Plus, it has a high-quality LED (virtually heat-free and with a 75% energy savings compared to halogen), is assembled in the USA, and is backed by an industry-leading 5-year warranty.
At a competitive price point that optimizes design, performance, and value, it’s pretty hard to pass up!
Why invest in new lighting?
As we said, lighting is often overlooked in terms of equipment upgrades…
But, just think of how many times per day you’ll use a good-quality light in your exam rooms or dental area.
In terms of cost per use, that can make new lighting a great investment—something you’ll benefit from using many times per day.
And if your new light makes your life easier in terms of visualizing the patient and making accurate medical notes… that’s an investment that could save you time and headaches, and be well worth it!