The Dangers of Essential Oils and Pets

Written by: Tabitha Schmidt, Client Care Supervisor

 

With essential oils becoming more popular in health, natural cleaning products, and relaxation it is good to know how this affects your furry house mates. Essential oils are the extracted organic components of plants that give them their characteristic fragrance or taste. They are popularly used for aromatherapy by inhalation (candles, incense, diffusers) or rubbing into the skin (perfumes and oils). They are also found in many insecticides, personal care products (e.g., antibacterials), flavorings, herbal remedies, and liquid potpourri.

Unfortunately, there are a lot of essential oils that are harmful to your cats and dogs, whether it be by diffusing machine or the oil itself. Our pets have a stronger reaction to these products than we do. Many essential oils are toxic to pets and may cause severe respiratory irritation, GI upset, liver failure, paralysis, and other life-threatening symptoms listed below.

Essential Oils Which are Poisonous to Dogs

According to the Pet Poison Helpline

  • Tea tree oil (Melaleuca oil)
  • European Pennyroyal/squaw mint
  • Oil of Wintergreen
  • Pine Oils

Essential Oils Which are Poisonous to Cats

According to the Pet Poison Helpline

  • Oil of Wintergreen
  • Oil of Sweet Birch
  • Citrus oil (d-limonene)
  • Pine oils
  • Ylang Ylang oil
  • Peppermint oil
  • Cinnamon oil
  • Pennyroyal oil
  • Clove oil
  • Eucalyptus oil
  • Tea tree oil

Symptoms to Watch Out For

A few red flags that we should be looking for are:

  • Behavior changes (depression, fatigue, weakness)
  • Difficulty breathing (labored breathing, fast breathing, coughing, wheezing)
  • Drooling and/or vomiting
  • Tremors
  • Ataxia (difficulty walking, stumbling, wobbling)
  • Redness or burns around the mouth or nose
  • Paralysis of the rear legs

Precautions to Take

Prevention is key. The precautions you can use are pretty simple. Keep these essential oils out of reach of children and your pets in a secure container and ask your primary veterinarian what you can use and what could be harmful to your pet. There are also alternative products that you can use that are calming and not harmful for you pet in a stressful situation that are available in treats, capsules, or liquids.

If you think your pet may have been exposed to an essential oil, please don’t hesitate to give us a call or bring your pet to the nearest emergency veterinarian. You may also consider calling the 24/7 Pet Poison Hotline with questions or for advice.

Western Reserve Partners Advises Ethos Veterinary Health

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Western Reserve Partners Advises Ethos Veterinary Health in its Growth Equity Recapitalization

CLEVELAND, OH (December 18, 2018)Western Reserve Partners, a division of Citizens Capital Markets, Inc., is pleased to announce that it served as the exclusive financial advisor to Ethos Veterinary Health, LLC (“Ethos” or the “Company”) in its recapitalization by Brown Brothers Harriman Capital Partners (“BBHCP”). Through the recapitalization, Ethos remains independently owned by its veterinarian professionals and, under the leadership of founding CEO Ames Prentiss, is well capitalized to further accelerate its acquisition-focused growth strategy.

Headquartered in Woburn, Massachusetts, Ethos is a leading provider of specialty veterinary health services with over 300 doctors of veterinary medicine throughout the United States. The Company’s unique integrated clinical model includes 21 specialty & emergency hospitals and a suite of complementary reference laboratory, compounding pharmacy and SaaS-based training services. The Company, formed in 2015 through the merger of four veterinary hospital systems, has since acquired six additional hospital systems and also earned a national reputation among veterinary professionals for providing exceptional quality-of-care, world-class professional development and a veterinarian-first culture. Through this minority equity recapitalization with Brown Brothers Harriman, Ethos has provided liquidity to its owners, gained a partner with significant experience scaling multi-unit healthcare businesses and positioned itself for future organic and acquisitive growth.

[Read More]

About Western Reserve Partners

Western Reserve Partners, a division of Citizens Capital Markets, Inc., provides M&A, capital raising and other financial advisory services to middle market companies across a focused set of industry verticals. We deliver thoughtful advice, keen market insight and superior execution to our clients, both nationally and internationally, and our managing directors average nearly 30 years of experience and have directly executed more than 700 transactions throughout their careers.

Western Reserve Partners is a part of Citizens Financial Group, one of the oldest and largest financial institutions in the U.S. Also, as a member of Oaklins, the world’s most experienced mid-market M&A advisory organization, Western Reserve Partners has unparalleled access to global companies and investors.

Pet Car Safety and Canine Seat Belts

Written by: Lucas Daly, Veterinary Technician

 

Most of us drive with our pets regularly, whether it is to the dog park, a vet appointment, or just running some errands around town. In most states it is required by law that people use vehicle safety devices (aka seat belts) to reduce the risk of serious bodily harm in the event of a collision or vehicular accident. The CDC states that “seat belts reduce serious crash-related injuries and deaths by about half.” This is great news and practice for us while on the road, but what about our canine companions that travel with us in the car?

With winter upon us here in New England, there is an increased risk of accidents and collisions due to winter travel conditions. While there are no seat belt laws for dogs, there is an increasing awareness and use of canine safety belt harnesses and restraints while traveling in the car.

What is a Canine Seat Belt?

Dog seat belts are more commonly known as dog car harnesses, which attach a full-body harness to the seat belt system in the back seat of the car. Dogs are safely and easily clipped in with a short leash. Most are customizable to the dog’s size and comfort.

Benefits of Dog Car Harnesses

Safety

First and foremost, dog car harnesses keep your dog safe. In the event of an accident, the harness and leash would minimize force on the dog’s neck, significantly reducing the risk of injury to both the dog and the driver. They also prevent dogs from falling or jumping out of the window which can cause serious injuries.

Most safety harness are crash-tested and DOT-approved, so your dog can have the same safety and security as you do with your seat belt.

A source of comfort for your dog

By securing your dog to one place with a dog car harness, your dog may feel less anxious and more secure while driving with you. It may also help with car sickness since they won’t be rocking and shifting around so much.

Minimize distracted driving

Many dogs tend to move around, fall over, or try to climb into the front seat with you while driving. This can be dangerous for the driver if it takes their eyes off the road or their hands off the wheel. By having your dog strapped in with a harness, the driver can focus on the road and not the antsy dog in the back seat.

Other Car Safety Options for Your Dog

  • Crate: A travel specific crate designed to be sturdy and padded, and sometimes strapped to the floor of the trunk of rear seat for added stability.
  • Back Seat Barrier: This barrier blocks the space between the front and back seats which prevents dogs from climbing into the front seat or tumbling forward in a crash.
  • Leash & Zip Line: Attaching to the car’s cargo hooks, this will provide security while allowing your dog to move around in the back seat.
  • Pet Car Seat: For smaller dogs or cats, a car seat designed especially for pets can keep your pet in place while still allowing them to see all the wonders racing by out the window.

The American Kennel Club has some suggestions on what to look for in both Safety Harnesses and Travel Crates. Additionally, the Center for Pet Safety has published crash test results and recommendations on safety harnesses.

Whichever method you choose, we fully support increasing safety for our clients and patients, and encourage anyone who travels by car with their pets to consider safety options for the coming winter months and beyond.

We wish you many more wonderful and safe adventures with your pets!

VSH Kicks Off Annual Holiday Pet Food Drive

VSH Kicks Off Annual Holiday Pet Food Drive

Now in its 7th year, Veterinary Specialty Hospital is proud to announce the start of our annual holiday pet food drive to help keep pets and their families together!  During the holiday season many families throughout San Diego have a difficult time feeding their human family members, let alone their furry companions. Working in partnership with the Jacobs and Cushman San Diego Food Bank, all dog and cat pet food items will be distributed within the community to benefit San Diego families and their four-legged friends.

During these times many will share what little food they have with their pet, and others will be forced to make the decision to surrender their pet to a shelter. According to the ASPCA, approximately 6.5 million animals enter U.S. animal shelters nationwide every year, with 1.5 million of them, euthanized annually. Today, families still find themselves struggling financially and must make the painful decision to give up their beloved pets to shelters, because they cannot afford to feed them or to care for them.

Donations can be dropped off in the lobby of the North County or San Diego Veterinary Specialty Hospital. For those who prefer online shopping or might be too busy to make a trip to one of the drop-off sites, please have food shipped directly to one of our hospitals (most pet food stores will ship for free!). Note: no glass, raw or homemade items, please.

Several of our referring partners are also participating in the pet food drive, with collection barrels located at their hospitals as well.  Participants include: Academy Animal Hospital, All Creatures Hospital, All Pets Animal Hospital, The Drake Center for Veterinary Care, Governor Animal Clinic, Kensington Veterinary Hospital, Pearson Animal Hospital, Poway Animal Hospital and The North County Credit Union.

Donations will be collected from December 1 through January 4, 2019. Please donate today!

Electrochemotherapy

Written By:  Courtney Zwahlen, DVM, DACVIM (Oncology)

Electrochemotherapy (ECT) is a local treatment for cancer using a combination of chemotherapy and electric pulse therapy which increases the antitumor effect of the chemotherapy drugs.

The procedure uses short high voltage pulses generated via an electric pulse generator machine. Once the pulses have been delivered, the cell’s plasma membrane has increased permeability to the chemotherapy agent which is administered either intratumorally or intravenously.

The two chemotherapeutics that have shown the most promise and are used most commonly are bleomycin and cisplatin.

  • Bleomycin, an antitumor antibiotic, is a hydrophilic drug that has very limited transport through the cell membrane but is extremely cytotoxic once bound to DNA. Bleomycin efficacy appears to be potentiated 1000 fold with electroporation of cells.
  • Cisplatin, a platinum containing chemotherapeutic, also has difficulty getting through the cell membrane but is quite cytotoxic once bound to DNA. Electroporation of cells showed increased cisplatin cytotoxicity up to 80 fold.

Mechanisms of Action

Various mechanisms of action of ECT have been described.  Electropermeabilization of the tumor cells leading to increased intracellular drug accumulation, vascular effects, and an increased immune response appear to be the most important.

The principal mechanism of action is increased cellular uptake of bleomycin or cisplatin by exposure of the tumor cells to an electric field (Fig. 1).

The vascular effects include two distinct changes, vascular disruption and vasoconstriction. The vascular disruption involves endothelial cell death and consequently a decrease in local blood flow. The vasoconstriction effect, also known as vascular lock, induces prolonged entrapment of the chemotherapy drug within the tumors.

The last mechanism of action involves antigen shedding by the tumor cells that are destroyed by ECT which can induce some systemic immunity.

Based on the various mechanisms of action of ECT, antitumor activity should be observed in many different types of tumors treated, regardless of their histological type.

An electric pulse applied at the time of maximal drug concentration in the tumor optimizes the antitumor effect. The best timing of the electric pulses for intratumoral administration is immediately after drug injection, whereas for intravenous administration it is 4-8 minutes after drug injection. The drugs remain at a sufficient concentration in the tumor for at least 20 minutes.  At longer intervals between electric pulses and chemotherapy administration, the antitumor effectiveness of ECT is decreased. Intratumoral delivery of chemotherapy generates higher drug concentrations locally in the tumor, and lower concentrations in the non-target tissues when compared to intravenous administration. The drug doses are so low whether administered intratumorally or intravenously that they have minimal to no systemic side effects.

Fig. 1
a. Anticancer drug surrounding the cell
b. Electroporation exposes a cell to a high-intensity electric field that temporarily destabilizes the membrane. During this time the membrane is permeable to the anticancer drug surrounding the cell.
c. When the field is turned off, the pores in the membrane reseal, enclosing drugs inside.
Source: Leroy Biotech 

Procedure

The treatment procedure consists of anesthetizing the patient, injecting the chemotherapy either intratumorally and/or intravenously, waiting the appropriate amount of time and then applying the electric pulse (Fig. 2).

In order to get good contact between the electrodes and skin, KY or ultrasound gel is used.  Only minor immediate side effects have been noted in people and animals treated with ECT. The most common side effect reported is involuntary contractions/spasms of the underlying muscle in the treated area, but the spasms are only present during the application of the electric pulses. Any associated pain dissipates immediately after the electric pulses are discontinued.  Another immediate side effect that has been observed is minor irritation locally.

More delayed side effects can occur and include erythema, edema, and possible necrosis of the tumor. In most cases, patients typically only need one to three treatments, and each treatment under general anesthesia typically takes about 20 minutes. In some cases, tumors may need more than one treatment, especially if the tumors are large.

Fig. 2
a. General anesthesia to ensure security of patient and practitioner.
b. Drug injection: Intratumoral or intravenous injection of cisplatin or bleomycin
c. Applying electric pulses: 8 pulses of 100 μs every 2 ms (ESOPE standard protocol 2006).
Source: Leroy Biotech 

Indications

Electrochemotherapy appears to be a promising and relatively inexpensive local treatment option for dogs and cats with a variety of tumors. It has been utilized for a variety of tumors including squamous cell carcinoma, soft tissue sarcomas, mast cell tumors, localized lymphomas, melanomas, transmissible venereal tumors, perianal adenomas, anal gland adenocarcinomas, sarcoids, and fibropapillomas (Fig. 3-5).

This technique can be used for incompletely excised tumors and/or tumors that cannot be excised without significant complication/deformity to the patient. It can be considered as an alternative to radiation therapy for those patients that are unable to undergo radiation therapy for various reasons.  I

The treatment can be performed on an outpatient basis, it is safe, and shows good long-lasting objective responses in approximately 80% of patients.

Patients often require 1-3 treatments given once every 2-4 weeks, depending on response.

Local side effects, such as tumor necrosis, are to be expected pending the amount of active tumor that is being treated.

Supportive care, such as bandage changes, anti-inflammatories and antibiotics, are utilized until the treated wound has healed.

Fig. 3
Incompletely excised soft tissue sarcoma over metacarpal region.
Images progress from escar formation, tumor necrosis, debridement and healed wound.
One year later, patient is comfortable with no scar or tumor recurrence.

Fig. 4 Epitheliotrophic Lymphoma affecting lower lip and gingiva.
a. Pre-treatment.
b. Immediately following treatment.
c. 9 days post treatment showing initial tumor necrosis.
d. 12 days post treatment with progressive tumor necrosis.
e. 21 days post treatment, healing mucosa.

Fig. 5 Feline nasal planum squamous cell carcinoma.
A. Before treatment
B. 2 weeks post
C. 4 weeks post
D. 8 weeks post. Complete response >1 year.
Source: Leroy Biotech 

The Danger of Grapes & Raisins to Dogs

Written by:  Erica O’Donnell, DVM, MRCVS

While many of us enjoy sharing snacks with our canine friends, many human foods are toxic to dogs including grapes and raisins.  At this time we do not know the exact toxic mechanism. The toxicity is idiosyncratic, meaning that there is no way to predict which dogs will be affected or not, and some dogs will experience toxicity from a small ingestion while others can ingest large amounts without any obvious problems. Even a small amount in a susceptible dog can be fatal.  Dogs of any age, breed, or gender can be affected.  One of the most serious complications of grape and raisins is that they can cause severe kidney damage leading to acute kidney failure. Clinical signs can include vomiting, diarrhea, decreased appetite, lethargy, weakness, abdominal pain, oliguria (passing only small amounts of urine), or changes in urination or drinking pattern.

If you witness your dog ingesting grapes or raisins, it should be considered an emergency and veterinary evaluation should be sought out immediately. Vomiting should be induced as soon as possible, before the toxins within the fruit can be absorbed.  This should ideally be performed at a hospital under veterinary supervision, and absolutely should not be performed at home if your dog is having trouble breathing, showing any signs of distress, or is lethargic.   You should consult a veterinarian by phone or call Poison Control if you are unable to seek veterinary attention so that vomiting can be induced in as safe a manner as possible.  The next step in decontamination is typically administration of activated charcoal, which binds up any toxin left in the gastrointestinal tract.  Baseline bloodwork and urine testing will be performed to assess for evidence of kidney damage, and kidney values should be checked daily for a few days since renal failure can take up to 72 hours to become apparent in some cases.  Fluid therapy is the mainstay of treatment for grape or raisin toxicity and is typically recommended for 2-3 days.

Most cases of grape or raisin ingestion are diagnosed as a witnessed ingestion, but a veterinarian should still be consulted as soon as possible if partially digested grape or raisin bits are found in feces or vomit.  The best treatment is prevention – keep raisins and grapes out of reach of your dog and notify family members of the toxic potential of these foods.

 

Platelet-rich plasma (PRP): A newer biological approach to age-old treatment difficulties

Written by: Kristian Ash, BVMS, MRcVS, DACVS-SA

What is PRP?

Regenerative medicine is one of the newest fields of medicine and aims to prompt the body to heal itself by using the bodies own cells and substances to restore and repair damaged tissues. Although still in its infancy, regenerative medicine techniques are starting to permeate the veterinary field. When used in the orthopedic field, regenerative medical treatments (Stem cells, PRP, IRAP) are referred to as orthobiologics. The most widely used orthobiologic in small animal clinical practice is platelet-rich plasma.

Platelet-rich plasma (PRP) is an autogenous concentrate composed primarily of platelets and white blood cells. It is used as a biological supplement to facilitate delivery of vital growth factors required to stimulate healing. Although the utility of PRP is continually being expanded, its use in veterinary medicine is primarily associated with wounds and orthopedic applications.

A benefit of PRP is that it is not administered systemically, but rather applied directly to the site of tissue damage by intra-articular injection, peri-tendinous injection, or topical application.

Physiology/pharmacology

Platelets are among the first wave of cells that migrate to a site of injury following tissue trauma. Not only do they provide a critical hemostatic function, but they also release and provide growth factors required to stimulate the healing process. Platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-β1 and TGF-β2), vascular endothelial growth factor (VEGF), basic fibroblastic growth factor, and epidermal growth factor (EGF) are all brought to the site of injury from the alpha granules of platelets.

Of particular importance, are the delivery of PDGF and TGF-β.  PDGF stimulates angiogenesis, mitogenesis, and activation of macrophages.  TGF-βaccelerates the production of collagen from fibroblasts.

PRP may also help to decrease inflammation by modulating interleukin-1 production.

Extraction

PRP is made by centrifugation of a whole blood sample. The resultant buffy coat and plasma are then extracted, and the leucocyte concentration further reduced.
The resultant concentrate has approximately 4-8 times the concentration of platelets than whole blood. During the preparation process, white blood cells are filtered out, as increased leukocyte concentrations have been linked to increased scar tissue formation, increased collagen degradation, and decreased tendon matrix production.

The platelet concentrate can then be used as a small volume liquid, or can be mixed with thrombin and calcium chloride to produce platelet-rich fibrin (PRF) gel.

Applications

Applications for PRP in small animal veterinary medicine are ever expanding. Currently, the most common applications appear to be in osteoarthritis (OA) management as well as tendon and ligament healing.

Intra-articular injections of PRP have been used in the treatment of osteoarthritis. Managing OA can be exceedingly frustrating due to the poor healing characteristics of articular cartilage. The avascular nature of articular cartilage severely limits the efficacy of systemic treatments. Local delivery of growth factors therefore is markedly advantageous to stimulate reparative processes on the joint surface. The evidence for PRP in osteoarthritis models in dogs is mounting. A randomized controlled clinical trial performed in 2013 showed subjective and kinetic improvement in gait 12 weeks following PRP injections for OA of a single joint. Likewise, a 2016 trial showed efficacy of multiple intra-articular injections of PRP following arthroscopic treatment for canine elbow dysplasia. Based on these studies, PRP injections following arthroscopic elbow surgery are one of the most common applications of PRP here at PEAK.

Another exciting area for the use of PRP is in aiding tendon and ligament repair. As with articular cartilage, the vascular supply to tendons and ligaments is typically poor and as such, limits their intrinsic healing capacity. Local administration of PRP to healing tendons and ligaments may help increase the likelihood of successful repair. A recent study in 2016 showed improved healing of the Achilles tendon when PRP was used as an adjunctive treatment to surgical repair. We now use PRP injections with all our Achilles tendon repairs and have found the results excellent.

Limitations

As with any therapeutic intervention, PRP does have its limitations and considerations. Its use in treating cranial cruciate disease, the most common ligament injury we face in small animal practice, is limited. A 2016 study compared dogs treated with PRP alone versus those treated with nothing. The results showed improved cartilage health, limb function, and range of motion using multiple PRP injections over a 6 month period, however the cranial cruciate ligament continued to degenerate and there was no difference in the radiographic appearance of OA regardless of whether or not PRP was administered.  In an unrelated 2016 study where PRP was used alone to treat partial tears of the cranial cruciate ligament following arthroscopy, the results were encouraging with 30% of patients showing some improvement in gait, yet only 25% of patients had documented improvement in the health of the cranial cruciate ligament. These results suggest that PRP can be an effective therapy following surgical stabilization of the stifle to help in decreasing the effects of ongoing osteoarthritis, but that it is ineffective in the management of partial or complete cruciate ligament ruptures.

The risks associated with PRP injections are very low as it is a product of the patient’s own blood. The biggest risk associated with PRP is septic arthritis, an extraordinarily rare consequence of any intra-articular injection.

Conclusion

Platelet-rich plasma injections are a low risk, promising new regenerative therapy that may aid in the treatment of challenging orthopedic conditions in small animal veterinary medicine. The clinical use of PRP is increasing as the level of evidence for its efficacy continues to expand.

Ethos Supports Initiative to Establish Standard Title and Scope of Practice for Veterinary Technicians

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Woburn, Mass., August 24, 2018 –Ethos Veterinary Health (Ethos) has developed a position statement in support of NAVTA’s Veterinary Nurse Initiative (VNI). The initiative by the National Association of Veterinary Technicians in America is aimed at establishing a national credential for Registered Veterinary Nurses (RVN).

Ethos fully supports this work given its importance in improving patient care. “Ethos has a strong commitment to the continuous growth and development of our team members, and we believe the Veterinary Nurse Initiative provides a crucial guiding framework to help us achieve this goal,” said Patrick Welch, DVM, MBA, DACVO, Chief Knowledge Officer of Ethos Veterinary Health.“We are excited to take an active role in supporting NAVTA in their efforts around this initiative.”

The statement reads as follows:

Ethos Veterinary Health mission is to provide unsurpassed veterinary health care for patients and their human companions. We recognize the vital role that veterinary technicians play in the integrated veterinary healthcare team, and that this collaborative approach to care is essential to achieving this mission.

We support the goals of the Veterinary Nurse Initiative (VNI) to unite the profession with one standard title and scope of practice. The VNI will increase public awareness of the profession and elevate and align practice standards, leading to better patient care and consumer protection. These goals are consistent with our core values of collaboration, continuous development, innovation, quality, and teamwork. Ethos Veterinary Health is proud to support the Veterinary Nurse Initiative.

For more information about Ethos’s support of this initiative please contact Ed Carlson at ecarlson@ethosvet.com.

About Ethos Veterinary Health

Ethos is a veterinary health company with hospitals across the U.S. providing advanced medical care for pets. Our approach includes a focus on transformative science, continuous learning and growth for team members and collaboration.

 

Laryngeal Paralysis Review

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Written by Kurt S. Schulz, DVM, DACVS

Laryngeal paralysis is one of the most common causes of respiratory dysfunction and distress in older large breed dogs.  It may present either as a chronic progressive increase in upper airway noise and exercise intolerance or as a respiratory emergency with severe inspiratory distress.  Fortunately, surgical treatment is highly successful with infrequent complications and a high degree of client satisfaction.

Causes and pathophysiology

The specific causes of acquired laryngeal paralysis remain uncertain but are associated with dysfunction of the laryngeal muscles and recurrent laryngeal or vagus nerves.  The primary muscle responsible for abduction of the arytenoid is the cricoarytenoideus dorsalis which is innervated by the recurrent laryngeal nerve. This neuromuscular mechanism may undergo idiopathic failure in older large breed dogs leading to inspiratory difficulty.  The clinical signs are exacerbated by heat and exercise due to the effects of increased respiratory effort on the rima glottidis.

The rima glottidis is the opening between the arytenoids and represents a narrowing in the airway when laryngeal paralysis occurs.  Heat and exercise increase the rate of flow through the upper airway and the narrowing at the rima glottidis results in a region of low pressure at the rima due to the Venturi effect.  The result is that increased respiratory effort results in further narrowing of the rima glottidis and further dyspnea.  The patient experiences increased stress and temperature resulting in an additional increase in respiratory effort and further narrowing of the rima glottidis. Ultimately the end results of laryngeal paralysis particularly in periods of increased heat and exercise are hypoxia, hyperthermia and moderate to severe stress.  A secondary result can be aspiration due to ineffective laryngeal adduction and eventually aspiration pneumonia.

The association between acquired laryngeal paralysis and generalized neurologic disease remains controversial.  Several studies have suggested that a significant percentage of dogs with laryngeal paralysis may have or develop generalized neurologic signs and that those with generalized neurologic disease at the time of diagnosis have a greater risk of complication and poorer prognosis than those without.

Infrequently, dogs may present with congenital laryngeal paralysis.  The most common breeds identified with laryngeal paralysis are Bouviers des Flandres and Siberian huskies. Many dogs with congenital laryngeal paralysis are younger and frequently show signs of other neurologic disease.  Many of these patients will have progressive neurologic deterioration and owners should be cautioned of this likelihood prior to electing surgery.

Diagnosis

There is a broad variety of presentations of laryngeal paralysis although most dogs are older and males are two to four time more commonly affected than females. The Labrador retriever is the most common breed presented although other breeds such as golden retrievers and spaniels are also over-represented. Traumatic laryngeal paralysis secondary to bite wounds or other cervical trauma may present in any breed of dog or cat.

History

Owners often report progressive exercise intolerance, increased respiratory effort in the heat, increased respiratory noise and intermittent gagging. Mild cases may only result in clinical signs or increased noise during significant exertion. We commonly see two groups of presentations.  In the first group the patients present with a normal respiratory effort and attitude but a distinct raspy upper airway noise is evident. There may be a history of gagging and increased respiratory noise when sleeping. The second group presents as a respiratory emergency with severe upper airway distress and possible hyperthermia.

Treatment of patients in severe upper airway distress is directed at supplementing oxygen, sedation, and cooling if indicated by hyperthermia.  Treatment of the stress by sedation is probably the single most important action to stop the cycle of hypoventilation and subsequent increased respiratory effort triggered by stress.  In the most severe cases, we will anesthetize and intubate the patient and either recover them from the anesthesia slowly and continue sedation or take them immediately to surgery for a laryngeal tie back.

Thoracic radiographs should be obtained in all cases of suspected laryngeal paralysis to evaluate for aspiration pneumonia or co-morbidities.

Definitive diagnosis of laryngeal paralysis is made by laryngoscopy with the patient under light anesthesia. We avoid all premedications during this procedure to decrease the risk of false positive results. We generally use i.v. propofol alone and want the patient at a plane of anesthesia where they are actively taking deep breaths on their own.  The oral cavity and naso- and oropharynx are examined for any masses or other disease. The arytenoid function is then carefully evaluated in conjunction with monitoring the patient’s inspiration and expiration. It is critical to coordinate the respiration with the movement of the arytenoids to avoid a false negative test.  Other methods of diagnosis including ultrasound or flexible endoscopy have not proven as effective as laryngoscopy.

Treatment

Medical treatment of mild laryngeal paralysis is often directed at modification of lifestyle. Exercise moderation should be prescribed particularly in warmer weather and weight management may aid in reducing the risk of hyperthermia and overexertion. Elevated feeding and decreasing the speed of water consumption with water bowl obstacles may decrease the risk of aspiration.

Surgical treatment is directed at enlarging the rima glottidis or bypassing the larynx by permanent tracheostomy.  Most surgeons elect unilateral arytenoid lateralization (tie back procedure) due to the high success rate and lower complication rate than other procedures.

A permanent tracheostomy should not be necessary for treatment of laryngeal paralysis except in rare cases of laryngeal collapse.  Tracheostomies require regular care by the owners and may contribute to additional tracheal disease.

Partial laryngectomy may be performed by an oral approach or ventral approach and may utilize laser or routine hand instruments.  Complications including webbing and subsequent airway obstruction can be severe and the degree of airway opening is less predictable than with the tie back procedure.

Unilateral arytenoid lateralization (tie back) is the most common surgical procedure for laryngeal paralysis. A lateral skin incision is made over one side of the larynx and the cricoarytenoidius dorsalis muscle is replaced with a non-absorbable suture that holds one of the arytenoids in permanent abduction.  Bilateral lateralization is rarely indicated.  The surgical procedure is approximately 45 minutes to an hour and the rima glottidis is checked during the procedure to ensure adequate opening. We use a non-absorbable braided suture due to its strength and the size and curvature of the needle.  Unlike many surgical procedures, the tie back procedure is based more on palpation than vision and the nature of working in a very tight anatomical region necessitates a perfect needle size and curvature.

Postoperative care and complications

Patients undergoing arytenoid lateralization have instant relief of the airway obstruction and demonstrate a dramatic difference in attitude and respiration within minutes of anesthetic recovery.  We take numerous precautions to limit aspiration pneumonia during the recovery period including the use of antacids, broad spectrum antibiotics and metoclopramide in addition to recovering the patients with an elevated head and thorax. These patients demonstrate very little surgical pain and, like most Labradors, are eager to eat as soon as permitted.  We feed soft meatball shaped food for the first two weeks and then gradually return them to their normal diets.

The most common complication of the tie back procedure is seroma formation at the incision site due to microvasculature and dead space formation.  Aspiration pneumonia is reported any time postoperatively in 10 to 20% of cases although our records suggest our hospital rate is closer to 6%. Most aspiration pneumonia can be medically treated on an out patient bases.  We are aware of only two cases of elective euthanasia due to aspiration pneumonia from patients in our hospital.  Over a 10-year period we have re-operated 2 patients after failure of the cartilage or suture with successful revision in both cases. Initial failure may be due to inappropriate suture placement or brittle cartilage. Owners should also be informed that following the tie back procedure, dogs will not be able to generate a normal bark sound although many have had a voice change preoperatively as well.

The overall survival rate following tie back surgery is 94%, 90% and 85% at 1,2 and 3 years postoperatively respectively.  The overall client satisfaction rate is greater than 95% in our hospital. Successful surgical treatment of laryngeal paralysis can eliminate or drastically reduce the risk of upper airway distress and hyperthermia and significantly improve exercise tolerance.  The decrease in stress to the owners and the patient is immeasurable.  While the risk of complications with tie back surgery can never be completely eliminated, the high client satisfaction rate and significant survival times support the use of surgical treatment in the majority of patients.

Ethos Continues to Show Strong Growth in Q1 2018

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WOBURN, Mass. (BUSINESS WIRE) — Ethos Veterinary Health (Ethos), a leading independent veterinary health company, just finalized its third acquisition since December 2017, expanding its presence across the U.S. Integrative Pet Care in Chicago, Veterinary Emergency + Referral Center of Hawaii, in Honolulu, and Atlantic Street Veterinary Hospital Pet Emergency Center in Roseville, CA, have recently joined Ethos.

Ethos has significantly expanded its scope and now operates 17 veterinary specialty hospitals, which includes a team of more than 360 clinicians, and a suite of complementary services. These include Ethos Diagnostic Science, a San Diego-based reference lab with new locations in Boston and Denver; Ethos Veterinary Compounding, a compounding pharmacy; and VetBloom, an innovative online learning platform.

With its unique approach of integrating clinical medicine with science and education, and focus on vision, values and culture, Ethos is a great option for veterinary practice owners who are looking to join a larger organization or for a retirement option. A contributing factor to Ethos’ momentum is the increase in practice owners seeking out Ethos.

“It was very important for us to be part of a growing organization that respects the veterinarian and the practice. Ethos was the right partner for us.”

Will Coleman, DVM
Associate Medical Director and former owner of Veterinary Emergency + Referral Center of Hawaii

Ethos is currently an active buyer and interested parties can contact Brian Cassell at bcassell@ethosvet.com for more information.

About Ethos Veterinary Health

Ethos is a veterinary health company with 17 hospitals across the U.S. providing advanced medical care for pets. Our approach includes a focus on transformative science, continuous learning and growth for team members, and collaboration. For more information, visit ethosvet.com.