Tuesday, December 29, 2009
Tinocordin (immumod) for immunity stimulation
SAVIN Board 3: Immune modulators in Skin Diseases
Board innitiated by Dr Swarupmay Majumdar.Swarupmay Majumdar Boxer, Male, 4 yrs. H/ O- regular skin problems, been treated by many vets with antibiotics and steroids. relapses aftre initial improvements, frustrated owner wants something to be done.
P/E finding : generalized & symmetrical areas of alopecia & epidermal collarette. nodules all over dorasum, greasiness, typical smell,... halitosis, weight loss over 1 month, trebling on standing, interdigital ulcerated wound. already on predinsolone, bayrocin. regular food: on beef ,rice, eggs, biscuits,milk.
how to go ahead, what an all to think, shall do blood work ,urine tests, any suggestions please.
Sat at 13:04 ·
Saurabh Saxena
this is wat i wud do-a hot warm bath with petben shampoo for atleast 20 minutes followed by amitraz dip.dental cleaning and appl. of silverex cream on open wound.stop predni and beef.
Sat at 18:25 ·
Swarupmay Majumdar
ok, good. But I would like you to go more deep, why is it coming again and again. can it be anything related to diabetes? food allergy? what else....
Sat at 18:27 ·
Saurabh Saxena
doc ,ur principle -keep things simple...follow the bath atleast 2 times in week for a month.notice the progress
Sat at 18:33 ·
Sivashankar Ramakrishnan
Majum Thyrid Check Kiya Kya?
Sun at 13:35 ·
Swarupmay Majumdar
I am going to do that.
Yesterday at 13:16 ·
Swarupmay Majumdar
Actully I did not think abt thyroid, as he was loosing wt. I just put him on fatty acids, bayrocin, no steroids,kidspro food, and rantac. discussed with owner about food related allergy and advised them avoid the list of food and if possible change to Hypoallergenic from RC. Dog is better. yesterday I just tried on him Levamisole just to see whether it improves its immunity!!
Yesterday at 13:39 ·
Gautam Unny
try tinocordin (immumod) for immunity stimulation, its very good and effective. i have always wondered why vets ever use steroids on the skin, unless really needed. its the simplest way to disaster. would like the dog on griseofulvin 50mg/kg/day for 21 days with fat in the diet.
Yesterday at 18:33 ·
Swarupmay Majumdar
I had stopped using unnecessary steroids long back in the college days and been laughed at. I will try immumod. Is it a syp or tablet or injection? dose ?
Yesterday at 20:24 ·
Gautam Unny
Immumod is available as a tab nd syrup. I dont know the exact dose as its not there in any text. I use 100mg for 10 kg dog. available as a 100 nd 500 mg tab
Yesterday at 20:25 ·
Friday, December 25, 2009
Sucralfate
For Veterinary Use
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Basic Information
Sucralfate is a hydroxy aluminum salt of sucrose octasulfate that acts as a local-mucosal adherent. In an acidic environment, sucralfate forms a sticky viscose gel that adheres to protenacious exudates within an ulcer crater. This "band aid" effect lasts about six hours. At a higher pH, sucralfate may remain in suspension, but may improve the gastric environment by adsorbing pepsin, buffering hydrogen ions, stimulating prostaglandin E, increasing bicarbonate secretion, stimulating mucous secretion and binding epidermal growth factor. The absorption of sucralfate is minimal; its actions are local rather than systemic and it does not affect gastric acid output or enzyme activity. Sucralfate is used in the treatment of oral, esophageal, gastric, duodenal and colonic ulcers. Usually, sucralfate is given on an empty stomach.
Dogs and Cats
Sucralfate is used for the treatment of ulcers and upper GI disorders of dogs and cat. Common causes of GI erosion and ulceration in dogs include drugs (particularly NSAIDs and corticosteroids), toxic chemical ingestion, liver disease, renal failure, carcinoma, stress (trauma, shock, sepsis and burns), inflammatory bowel disease, mast-cell tumors, hypoadrenocorticism and any condition causing an excessive secretion of gastric acid.
Side effects are rare. Constipation and hypo-phosphatemia may occur in a small percentage of patients.
Precautions
• Sucralfate may decrease the rate of gastric emptying and slow GI transit time.
Drug Interactions
• Sucralfate may affect the absorption of many drugs and, in general, administration should be separated for other oral drugs including: NSAIDs, H2 receptor antagonists, fluoroquinolones, digoxin, ketoconazole, levothyroxine, penicillamine, tetracyclines, fat-soluble vitamins and warfarin.
Overdose
• It is unlikely that an overdose of sucralfate will cause clinical problems because it is so poorly absorbed. Very high doses (50X) have been administered to laboratory animals without mortality.
Acepromazine Maleate
For Veterinary Use
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Basic Information
Acepromazine maleate is a phenothiazine derivative that is used as a neuroleptic agent in veterinary medicine. It is a commonly used tranquilizer for dogs, cats and horses. Phenothiazines decrease dopamine levels and depress some portions of the reticular activating system. Acepromazine is metabolized by the liver and excreted in the urine.
In addition to tranquilization, acepromazine has multiple other important systemic effects including anti-cholinergic, anti-emetic, antispasmodic, antihistaminic, and alpha-adrenergic blocking properties. Acepromazine causes hypotension due to decreased vasomotor tone. It may change heart and respiratory rate, and thermoregulatory ability allowing for either hypo- or hyperthermia.
Acepromazine may be given intramuscularly, intravenously or orally. It provides no analgesia and the tranquilizing effect of the drug can be overcome unexpectedly particularly by sensory stimulation. Acepromazine is usually less effective if given after the animal is excited. There is a great deal of individual variability in the response to acepromazine and despite being a very commonly used medication there are important species and even breed differences in response to acepromazine that need to be taken into consideration (see precautions).
Dogs and Cats
Acepromazine is one of the most commonly used tranquilizers for cats and dogs. It decreases anxiety, causes central nervous system depression, and a drop in blood pressure and heart rate. It may be used in conjunction with atropine as a pre-operative medication for anxiety and for its antidysrhythmic effects. Oral acepromazine may be prescribed to prevent motion sickness, to temporarily reduce itching and scratching due to allergies, or prior to office visits, nail trimming or grooming appointments if the animal is too fractious to handle safely without sedation. Some veterinarians are reluctant to prescribe acepromazine for travel anxiety when the animal may be exposed to temperature extremes, such as during plane travel, or when there may be limited access to veterinary care. Other drugs used for travel anxiety/motion sickness include meclizine, diphenhydramine, and diazepam. Occasionally, animals (particularly cats) may have a paradoxical response to acepromazine and become excited, or aggressive.
Horses
Acepromazine is one of the most commonly used tranquilizers for horses.
It may be used alone or in combination with other sedative drugs such as xylazine, detomidine, or butorphanol. Because acepromazine lowers blood pressure by dilating small blood vessels, it is sometimes prescribed in the early treatment of laminitis in order to diminish vaso-spasm and possibly improve circulation within the hoof. Acepromazine is also used in horses that are prone to exertional rhabdomyolysis both as a preventative, and as a part of the treatment due to its vasodilatory properties. When acepromazine is used in the treatment of more severe cases of exertional rhabdomyolysis, intravenous fluids may be desirable to increase hydration and support renal function.
Onset of action of acepromazine varies with route of administration: oral acepromazine may take 30 minutes to an hour. The effects of acepromazine will last from 1 to 4 hours, but this varies significantly with dose and among individual horses. Acepromazine is a prohibited substance in most sanctioned competition. Oral administration or long-term, repeated dosing may increase detection time.
Side Effects
• Common: Acepromazine will cause hypotension, decreased respiratory rate and bradycardia. Dogs are particularly sensitive to cardiovascular side effects but cardiovascular collapse has also occurred in cats. Sudden collapse, decreased or absent pulse and breathing, pale gums, and unconsciousness may occur in some animals.
• Rare: fatal interactions with anesthetics have been reported.
• Acepromazine will cause a dose dependent decrease in hematocrit in both dogs and horses. This effect occurs within 30 minutes of administration and may last for 12 hours or more. The hematocrit in horses may decrease by as much as 50%.
• Penile paralysis is a rare but recognized adverse side effect of acepromazine use in the horse. This drug should be avoided in breeding stallions.
Precautions
• Acepromazine lowers blood pressure: it should not be used in animals that are dehydrated, anemic or in shock.
• Acepromazine should be avoided or used with extreme caution in older animals, or those with liver disease, heart disease, injury, or debilitation. If it is used in these animals, it should be given in very small doses. In some older animals, a very small dose can have a marked and very prolonged effect.
• Acepromazine should not be used in animals with a history of epilepsy, those prone to seizures, or those receiving a myelogram because it may lower the seizure threshold.
• Acepromazine should not be used in animals with tetanus or strychnine poisoning.
• Acepromazine should be avoided in pregnancy or lactation. It should be avoided or used with extreme caution in young animals due to its effects on an animal's ability to thermo regulate.
• Dogs: Giant breeds and greyhounds may be extremely sensitive to acepromazine, while terriers may require higher doses. Brachycephalic breeds, especially Boxers, are particularly prone to cardiovascular side effects (drop in blood pressure and slow heart rate). Acepromazine should be avoided or used with great caution in these breeds.
• Horses: Draft horse breeds are especially sensitive to most sedatives including acepromazine. Pony breeds do not appear to differ from horses in their response to acepromazine.
Drug Interactions
• Animals receiving acepromazine will require lower doses of barbiturates, narcotics, and other anesthetics. These combinations increase central nervous system depression.
• Antidiarrheal mixtures like Kaopectate and Pepto-Bismol, or antacids decrease the absorption of oral acepromazine.
• Acepromazine should not be used within one month of deworming with organophosphate compounds.
• Quinidine, epinephrine, propanolol, procaine hydrochloride and phenytoin have all been shown to have significant drug interactions with phenothiazines. Further information should be sought before concomitant administration.
Overdose
• Overdose will cause excessive sedation, slow respiratory and heart rate, pale gums, unsteady gait, poor coordination, and inability to stand. It may also cause sudden collapse, unconsciousness, seizures and death.
• Oral overdose should be treated by emptying the stomach along with monitoring and other supportive care.
• Phenylephrine and norepinephrine are the drugs of choice to treat acepromazine-induced hypotension. Barbiturates, or diazepam may be used for the treatment of seizures associated with overdose.
Enalapril For Veterinary Use
Enalapril acts as a competitive inhibitor of the ACE responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and when its concentrations are decreased, peripheral vascular resistance decreases, blood pressure decreases, aldosterone levels are reduced and plasma-renin activity is increased.
Enalapril is used to treat chronic renal failure and proteinuria. By blocking the production of angiotensin II, enalapril causes vasodilation of the glomerular-efferent arterioles, decreases intraglomerular pressure and reduces the glomerular filtration rate (GFR). The improvement in renal function is postulated to be due to the anti-hypertensive effect, the reduction in mesangial-cell proliferation and renal vasodilation, which causes a decrease in renal-filtration pressure and decreased proteinuria.
• If an animal shows adverse effects due to enalapril, withdrawal followed by a lower dose or a longer dosing-interval may be helpful. Severely azotemic animals should start with once-a-day dosing while being closely monitored for renal function.
• Some dogs appear to be dependant on the effects of angiotensin II for maintaining GFR. While this is unusual, this subpopulation will not tolerate ACE-inhibitor drugs.
• Enalapril should be avoided in pregnant or lactating animals.
• NSAIDs, including aspirin, should be avoided in animals on enalapril.
Overview
Therapeutic Class
Angiotensin-converting enzyme (ACE) inhibitor
Species
Dogs and Cats
Commonly prescribed by vets for:
Congestive heart failure (CHF), hypertension, chronic renal-failure, protein-losing nephropathies.
Vet drug status Status
Approved for use in the dog; however, no veterinary products are commercially available.
Therapeutic Class
Angiotensin-converting enzyme (ACE) inhibitor
Species
Dogs and Cats
Commonly prescribed by vets for:
Congestive heart failure (CHF), hypertension, chronic renal-failure, protein-losing nephropathies.
Vet drug status Status
Approved for use in the dog; however, no veterinary products are commercially available.
Basic Information
Enalapril is an ACE inhibitor that blocks the formation of angiotensin II. It is used as a vasodilator in the treatment of CHF and systemic hypertension. It is also used in animals with chronic renal failure and protein-losing nephropathies.Enalapril acts as a competitive inhibitor of the ACE responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and when its concentrations are decreased, peripheral vascular resistance decreases, blood pressure decreases, aldosterone levels are reduced and plasma-renin activity is increased.
Dogs and cats
Enalapril is used in dogs and cats for the treatment of CHF, occult-dilated cardiomyopathy and systemic hypertension. In large studies of dogs with moderate to severe heart disease due to mitral regurgitation or dilated cardiomyopathy, enalapril improved survival by greater than 100 percent, improved quality of life, improved exercise tolerance and decreased pulmonary edema. When treating CHF in dogs, enalapril is frequently combined with other drugs, such as furosemide, spironolactone or a positive-inotropic drug. Enalapril may be combined with beta-blockers in the treatment of occult-dilated cardiomyopathy or systemic hypertension. The value of enalapril in the treatment of degenerative-mitral valve disease of small breed dogs is still being investigated. While enalapril may be used to treat mild hypertension in cats, alodipine may be more effective for cats with severe hypertension.Enalapril is used to treat chronic renal failure and proteinuria. By blocking the production of angiotensin II, enalapril causes vasodilation of the glomerular-efferent arterioles, decreases intraglomerular pressure and reduces the glomerular filtration rate (GFR). The improvement in renal function is postulated to be due to the anti-hypertensive effect, the reduction in mesangial-cell proliferation and renal vasodilation, which causes a decrease in renal-filtration pressure and decreased proteinuria.
Side Effects
The most common side effects are hypotension, weakness, lethargy, GI upset (anorexia, vomiting or diarrhea), hyperkalemia and renal dysfunction. Although enalapril is used to treat chronic renal failure, there are instances of mild to moderate reversible renal failure, which may be precipitated by volume depletion superimposed on dilatation of the efferent arterioles.Precautions
• Patients receiving enalapril should be monitored regularly for arterial blood pressure, renal function and serum electrolytes.• If an animal shows adverse effects due to enalapril, withdrawal followed by a lower dose or a longer dosing-interval may be helpful. Severely azotemic animals should start with once-a-day dosing while being closely monitored for renal function.
• Some dogs appear to be dependant on the effects of angiotensin II for maintaining GFR. While this is unusual, this subpopulation will not tolerate ACE-inhibitor drugs.
• Enalapril should be avoided in pregnant or lactating animals.
Drug Interactions
• Diuretics and other vasodilators may increase the incidence of hypotension or hyperkalemia. Careful monitoring and adjustment of drug therapies may be necessary to reach the optimal therapeutic balance.• NSAIDs, including aspirin, should be avoided in animals on enalapril.
Overdose
• If an overdose is recognized promptly, gut-emptying protocols should be attempted. Hypotension is the most clinically significant problem when managing an overdose of enalapril. Hospitalization with volume expansion, blood-pressure monitoring and supportive care may be necessary.
Wednesday, December 23, 2009
Board 3- popttasium bromide in epilepsy
board 3: KBr in epilepsy
innitiated by Dr Swarupmay Majumdar18.12.2009
Swarupmay Majumdar I am treating many cases of Epilepsy. Recently KBR is available in Bangalore in tablet form for dogs. It is giving good result.
18 December at 19:50 ·Gautam Unny
whats the tradename doc? i have not found it here
19 December at 09:34 · Report
Kumar Vikas
Are you using of chemical origin, what protocol you are following
19 December at 15:39 ·
Kumar Vikas
Detail article avaible on epilepsy at http://www.ivis.org/advances/Vite/berendt/chapter_frm.asp?LA=1 this may be help ful review
19 December at 15:48 ·
Swarupmay Majumdar
there is company called progeny in bangalore ( pharma corporation of India) makes this generic medicine without any trade names. it comes in 60 tablets bottle. cost around 175 rupees.
Actually KBr is the oldest drug in epilepsy but not used in human beings. It is the drug of choice for dogs for long run. I have an article on this.
http://www.whereincity.com/medical/topic/brain-health/articles/758.htm
Actually KBr is the oldest drug in epilepsy but not used in human beings. It is the drug of choice for dogs for long run. I have an article on this.
http://www.whereincity.com
19 December at 16:27 ·
Swarupmay Majumdar
actually I had been treating a GSD M 2 yrs old with epilepsy. Its full blood data was normal. I put him on regualr Known therapy of gardenal 45mg bid with Ventriliv, provicalpet.
for sometimes he was finding vey difficult to manage the fits and we increased the dose to 60 mg bid. he was also on homeopathic medicine Verbena Mt, R33 and rescue remedy. Nothing worked still KBr was in . 300mg KBr tablets bid with 30mg gardenal bid. its takes some time ... 3 months atleast to reach steady KBr level. dog has no fits now but he finds difficult walking and lots of itching. Some how it was briught from the euthenesia table with KBr.
Need more disscussion on
1. KBr Vs NBr... See More
2. home care when dog is in fits
3.managing fits in clinic.
5. why these pets are best pets
6.rescu remedy and how it can help
for sometimes he was finding vey difficult to manage the fits and we increased the dose to 60 mg bid. he was also on homeopathic medicine Verbena Mt, R33 and rescue remedy. Nothing worked still KBr was in . 300mg KBr tablets bid with 30mg gardenal bid. its takes some time ... 3 months atleast to reach steady KBr level. dog has no fits now but he finds difficult walking and lots of itching. Some how it was briught from the euthenesia table with KBr.
Need more disscussion on
1. KBr Vs NBr... See More
2. home care when dog is in fits
3.managing fits in clinic.
5. why these pets are best pets
6.rescu remedy and how it can help
19 December at 16:35 ·
Kumar Vikas
As suggested by Dr Dinesh Dadarwal there is good article on epilesy at http://neuro.vetmed.ufl.edu/Neuro/courses/vem5384/VEM5384-lecture-4-seizure-cerebral.pdf
Sun at 09:02 ·
Board 2- vaccination reactions
Board 2:: innitiated by Dr Swarupmay Majumdar
Date 21.12.2009Swarupmay Majumdar I am going to look after a pug. Its 6 years now.This is the time for his regular vaccination, and owner brings to my clinic for his shots but inform me ,whenever he had his shots he had tough time.. breathless, vomiting, crying... how Do I go ahead and what shall I ask the owner to do? vaccination reactions related
Mon at 20:41 ·Gautam Unny
give him a dose of avil before starting the vaccine. keep him aat the clinic for an hour aand keep adrenaline handy.
Yesterday at 09:13 ·
Swarupmay Majumdar
can I give dexa, its short acting and may not affect vaccination?
8 hours ago ·
Gautam Unny
doc, im long out of college but if i remember right dexa is long acting and prednisolone intermediate acting. try this link. thats why i suggeseted pred
http://www.globalrph.com/corticocalc.htm
http://www.globalrph.com/c
7 hours ago ·
Swarupmay Majumdar
Actually I meant, If I use it once, will there be any problem with vaccination? I read your link also.
6 hours ago ·
Gautam Unny
prednisolone would be better as its shorter acting and will not supress antigen formation for long. i prefer it over dexa.
2 hours ago ·
Dr Gautam Unny, Member SAPOI
Member: Small Animal Practitioners of India
Dr Gautam Unny
Veterinarian
Dr Gautam is a Delhi Based vet who has many articles, books written by him. Dr Gautam is giving directions and anchoring in this group.
Dr Swarupmay Majumdar , member SAPOI
Member: Small Animal Practitioner of India
Dr Swarupmay Majumdar
Veterinarian
Many years of experience in veterinary care of small and companion animal . He is a Bangalore based veterinarian and helping in the moderation process of the Small Animal Practitioners of India.
Area Of Interest: feline medicine, dermatology, E-learning!!
contact: swarupmay@yahoo.com
Board 1 : Pug which was bleeding
Board on epistaxis
monday 21.12.2009
Innitiated by Saurav Saxena
Saurabh Saxena a pug ,female wt 4.9kg,during feeding suddenly developed bleeding from nose(one nostril),temp normal lost quite lot of blood wen reached clinic,used inj OTC,revici,botropase to stop healing,gave atropine n xylazine to anaesthetize took more than double usual dose to sleep for 1 hr ,blood in sneezing,dog very active,use...d ice bath also ,again after 2 hrs the bleeding restarted used inj calmpose,menadione .and adrenaline topically .wat can be the cause .no vaccination history.more likely a clotting disorder but is this normal and can it flare up just like that and what more can be done to check such continuous bleeding??thanks
sorry during second time the blood was cming more from mouth than nose..checked thoroughly no bone,foreign material or pyorrhea found??
See More
Mon at 09:05 ·
Saurabh Saxena
Saurabh Saxena
sorry again ,typing error in sec line"to stop bleeding"heheh
Mon at 09:06 ·
Gagan Gaudi
Gagan Gaudi
whats the blood picture i mean check for the platelets count if less can be put on steroids. u can tell the owner to keep the animal in a calm and quite space so that it dont get excited
Mon at 09:44 ·
Swarupmay Majumdar
Swarupmay Majumdar
apical abcess?
Mon at 10:47 ·
Saurabh Saxena
Saurabh Saxena
even i had a doubt abt platelet count but cant go for tests unless the animal stabilizes and once animal is ok,owner does not want to go for tests!!so a catch 22 situation...but the gud news is dog came today morning and is fit as a fiddle.
Mon at 18:00 ·
Swarupmay Majumdar
Swarupmay Majumdar
thats why sometimes we need to see things in very sipmle way !! not agreeing with me now?
Mon at 19:49 ·
Gautam Unny
Gautam Unny
doc platelet counts are needed whether the owner agrees or not, tell the owner to go off. that's our territory. if the pug does not agree will he take responsibility? no instead he'll blame us. so tests are needed. also vitamin K would have been advisable.
Yesterday at 10:09 ·
Saurabh Saxena
Saurabh Saxena
yup doc,mendione given in the first post.pug is fit but don know which drug actually saved him???
Yesterday at 11:39 ·
monday 21.12.2009
Innitiated by Saurav Saxena
Saurabh Saxena a pug ,female wt 4.9kg,during feeding suddenly developed bleeding from nose(one nostril),temp normal lost quite lot of blood wen reached clinic,used inj OTC,revici,botropase to stop healing,gave atropine n xylazine to anaesthetize took more than double usual dose to sleep for 1 hr ,blood in sneezing,dog very active,use...d ice bath also ,again after 2 hrs the bleeding restarted used inj calmpose,menadione .and adrenaline topically .wat can be the cause .no vaccination history.more likely a clotting disorder but is this normal and can it flare up just like that and what more can be done to check such continuous bleeding??thanks
sorry during second time the blood was cming more from mouth than nose..checked thoroughly no bone,foreign material or pyorrhea found??
See More
Mon at 09:05 ·
Saurabh Saxena
Saurabh Saxena
sorry again ,typing error in sec line"to stop bleeding"heheh
Mon at 09:06 ·
Gagan Gaudi
Gagan Gaudi
whats the blood picture i mean check for the platelets count if less can be put on steroids. u can tell the owner to keep the animal in a calm and quite space so that it dont get excited
Mon at 09:44 ·
Swarupmay Majumdar
Swarupmay Majumdar
apical abcess?
Mon at 10:47 ·
Saurabh Saxena
Saurabh Saxena
even i had a doubt abt platelet count but cant go for tests unless the animal stabilizes and once animal is ok,owner does not want to go for tests!!so a catch 22 situation...but the gud news is dog came today morning and is fit as a fiddle.
Mon at 18:00 ·
Swarupmay Majumdar
Swarupmay Majumdar
thats why sometimes we need to see things in very sipmle way !! not agreeing with me now?
Mon at 19:49 ·
Gautam Unny
Gautam Unny
doc platelet counts are needed whether the owner agrees or not, tell the owner to go off. that's our territory. if the pug does not agree will he take responsibility? no instead he'll blame us. so tests are needed. also vitamin K would have been advisable.
Yesterday at 10:09 ·
Saurabh Saxena
Saurabh Saxena
yup doc,mendione given in the first post.pug is fit but don know which drug actually saved him???
Yesterday at 11:39 ·
too many ideas spoils things::
too many ideas spoils things::
I had a call to visit a 8 months not vaccinated cat being bitten by a stray cat. The owner yells " my cat sinks.. its cold.. dyeing, please help". I went to see the cat at 11pm. By that time it was 46hrs post bite and many vets gave many opinion without seeing it. The owner had a busket fu...ll of all medicines.. augumentin,betnesol, liv52, nise syp, meloxicam, temobax, .... and the vet who saw it last 2 days said it will die, just admit in CUPA!!
My story could have been the sam ,if I had not gone there and seen. The cat had been going through internal bleeding, mucosa became pale,temp 102.3*f,not eating. wound is healthy ,no organs outside.
simple treatment.. stryptovit 1/5 every 8hrs, Relyte redyuse solution 1 tsp every hour, augumentin as before. The cat is fine now.
Outcome of story:: it is better to see the animal before prescribing and giving prognosis!! comments are welcome.
I had a call to visit a 8 months not vaccinated cat being bitten by a stray cat. The owner yells " my cat sinks.. its cold.. dyeing, please help". I went to see the cat at 11pm. By that time it was 46hrs post bite and many vets gave many opinion without seeing it. The owner had a busket fu...ll of all medicines.. augumentin,betnesol, liv52, nise syp, meloxicam, temobax, .... and the vet who saw it last 2 days said it will die, just admit in CUPA!!
My story could have been the sam ,if I had not gone there and seen. The cat had been going through internal bleeding, mucosa became pale,temp 102.3*f,not eating. wound is healthy ,no organs outside.
simple treatment.. stryptovit 1/5 every 8hrs, Relyte redyuse solution 1 tsp every hour, augumentin as before. The cat is fine now.
Outcome of story:: it is better to see the animal before prescribing and giving prognosis!! comments are welcome.
Tuesday, December 22, 2009
Imporatance of dermatological history
Dermatologic History
Clinical signs for various skin diseases are very similar and the etiology of a patient's problem may not be apparent based solely on the findings of a clinical examination. A thorough history will typically provide clues in regard to the cause of the skin disorder and allow the veterinarian to prioritize time-consuming and frequently costly laboratory tests needed to confirm the diagnosis. This decreases the time needed to extract a good history from the owner, helps ensure a complete history independent of stress levels and time constraints, and allows the client to think about her or his pet's skin problem for a little while without unnecessarily delaying the appointment schedule. Sometimes, it is necessary to ask the same question several times in different ways to obtain meaningful answers. I cannot overemphasize the importance of taking a good and efficient dermatologic history, which requires tremendous knowledge, experience, practice, and effective communication skills.
Question: What is the breed of the patient?
Relevance
Some breeds are predisposed to certain skin diseases and it may be worthwhile to keep a list of such breed predispositions in easy reach.
A list of reported breed predisposition is given in the Appendix. But beware, breed predispositions may vary with geographic location!
Question: How old was the patient when clinical signs were first recognized?
Relevance
Very young animals (puppies and kittens) are more commonly presented with congenital and hereditary defects, ectoparasites such as Sarcoptes scabiei, Otodectes cynotis, or Demodex canis, infections with bacteria (impetigo) or fungi (dermatophytosis) or, in dogs, canine juvenile sterile granulomatous dermatitis and lymphadenitis.
Young adult dogs are more commonly affected by demodicosis, atopic dermatitis, and flea-bite hypersensitivity, as well as idiopathic seborrhea an
d follicular dysplasia.
In middle age, hormonal diseases become a significant consideration, although allergies still occur in a significant number of animals, particularly in cats.
Neoplastic diseases are more commonly seen in older animals.
Question: How long has the disease been present and how did it progress?
Relevance
Acute onset of severe pruritus is frequently associated with scabies. Food adverse reaction may also have an explosive onset.
If pruritus was the first initial sign and lesions occurred later, then atopy or food-adverse reaction are most likely. Chronic nonlesional pruritus is typically due to atopic dermatitis or food adverse reaction, possibly complicated by secondary infections. Scabies incognito may also cause nonlesional pruritus.
If cutaneous signs have been present for years without the development of concurrent systemic signs, endocrine disorders are unlikely.
Nonpruritic alopecia for years without systemic signs points towards alopecia and follicular dysplasias or hereditary alopecia.
The presence of chronic wounds alone or associated with draining tracts necessitates the search for an infectious organism.
Diagnostic Procedures
Scabies treatment trial, skin scrapings elimination diet, cytology, bacterial culture, fungal culture, biopsy.
Question: Where on the body did the problem start?
Relevance
Outline typically affected sites of certain diseases.
Location of lesions and/or pruritus of various canine skin diseases.
Location of lesions or pruritus of various feline skin diseases.
| Location of lesions and/or pruritus | Common underlying diseases |
| Otitis externa | Atopy, food adverse reaction, parasites, polyps. Secondary infections are common and can also occur with primary endocrine disease! |
| Pinnae | Atopy, food adverse reaction, scabies, vasculitis, pemphigus foliaceus |
| Head/face | Demodicosis, atopy, food adverse reaction, dermatophytosis, insect allergies, scabies, discoid lupus erythematosus, pemphigus foliaceus |
| Paws | Demodicosis, atopy, food adverse reaction, Malassezia dermatitis, pemphigus foliaceus, metabolic epidermal necrosis |
| Claws | Bacterial or fungal infection, trauma, immune-mediated skin diseases |
| Tail base | Flea-bite hypersensitivity |
| Location of lesions and/or pruritus | Common underlying diseases |
| Otitis externa | Atopy, food adverse reaction, parasites, polyps. Secondary infections common! |
| Pinnae | Notoedres cati, vasculitis, pemphigus foliaceus |
| Head/face | Atopy, food adverse reaction, dermatophytosis, insect allergies, feline scabies, pemphigus foliaceus |
| Paws | Atopy, food adverse reaction, pemphigus foliaceus, trauma, plasmacytic pododermatitis |
| Claws | Bacterial infection, trauma, immune-mediated skin diseases |
| Tail base | Flea-bite hypersensitivity |
Question: Is the animal itchy?
Relevance
Pruritus is sometimes difficult to identify. Owners often do not consider licking, rubbing, or biting as clinical signs indicative of pruritus (we all have heard the story of the dog who is constantly licking its feet because "it is a very clean dog ..."). Several routine questions may be needed to identify pruritus in some patients: Are they licking or chewing their paws? The presence of pruritus with skin lesions does not help much in discovering the etiology of the pruritus, given that many skin diseases cause pruritus. However, pruritus without lesions typically means either atopic dermatitis or food adverse reaction (possibly with secondary infections) or in rare instances scabies incognito.
The perceived severity of pruritus may vary with the owner. Some owners deny the presence of pruritus despite the patient's frantic scratching in the consultation room. Others insist on severe pruritus in a patient with no evidence of self-trauma on clinical examination. Good communication skills and judgment are essential to form a realistic opinion for evaluation. If the pet's scratching wakes the owner up at night, the pruritus is severe irrespective of the presence of lesions.
If itch precedes the occurrence of lesions, atopic dermatitis, food adverse reaction, and scabies incognito must again be considered.
Diagnostic Procedures
Trichogram in alopecic patients that are reportedly nonpruritic.
Question: Is the disease seasonal?
Relevance
Insect bite hypersensitivities (caused most commonly by fleas, but mosquitoes or other insects can also be involved) frequently cause disease that worsens in summer. Whether clinical signs are absent or milder in the colder season depends on specific environmental conditions.
Atopic dermatitis may also be seasonal in certain climates. In many temperate climates it may occur more noticeably in spring and summer if caused by tree and grass pollens or worsens in summer and autumn because of weed pollens. Warmer climates such as those found in tropical or subtropical regions usually have an extended pollen season. Hypersensitivities to house dust mites are often nonseasonal, but may be seasonally worse in winter in some areas and patients.
Seasonal noninflammatory alopecia and hyperpigmentation may be due to cyclic follicular dysplasia.
Diagnostic Procedures
Insect bite trial, intradermal skin testing, serum testing for allergen-specific IgE, biopsy, keeping the animal inside to evaluate for mosquito-bite hypersensitivity.
Question: Are there other clinical signs such as sneezing, coughing, or diarrhea?
Relevance
Sneezing, coughing, wheezing, and conjunctivitis may be seen concurrently with atopic dermatitis and caused by airborne allergies.
Diarrhea may be associated with food adverse reaction.
Polydipsia and polyuria are common with iatrogenic and idiopathic hyperadrenocorticism.
Systemic mycoses frequently present with concurrent anorexia, lethargy, and with gastrointestinal or respiratory symptoms.
Diagnostic Procedures
Cytology of nasal exudate or conjunctiva, elimination diet, urine cortisol/creatinine ratio, low dose dexamethasone suppression test, and adrenocorticotropic hormone (ACTH) stimulation test.
Question: What is fed to the animal?
Relevance
Knowing the diet will allow the clinician to determine possible nutritional deficiencies.
It will also help in formulating an elimination diet if indicated (see Elimination Diet).
If a diet was fed in the past and it was not a true elimination diet (was not fed exclusively or not fed for an appropriate length of time) it may need to be repeated.
Contrary to the common belief, food adverse reactions typically do not occur immediately after a change in feeding habits. Most animals with food adverse reactions have been consuming the offending diet for years before showing clinical signs.
Remember to ask about treats and supplements, which are often forgotten, when food is discussed with the client.
Question: Are there other animals in the household? Do they show cutaneous symptoms?
Relevance
If other animals in the household are similarly affected, contagious disease such as dermatophytosis or scabies is more likely.
Other animals may serve as a reservoir for ectoparasites without showing clinical signs.
Diagnostic Procedures
If indicated, insect control trial, fungal cultures, or scabies treatment trials should include all animals in the household to identify and/or treat possible carrier animals to allow successful long-term remission for the patient.
Question: Does any person in the household have skin disease?
Relevance
Two zoonoses of major concern in veterinary dermatology are scabies and dermatophytosis (ringworm). However, even if owners are not affected, these diseases cannot be ruled out.
Canine scabies affecting humans occurs as an itchy papular rash in contact areas, such as arms and legs, starting days to weeks after onset of pruritus in the pet.
Dermatophytosis is often characterized by scaling and erythema and may not be particularly pruritic, but occasionally can present as severely inflammatory and pruritic skin disease. Dermatophytosis may sometimes be misdiagnosed as eczema in humans.
Sporotrichosis and other mycoses have zoonotic potential and may occasionally cause disease in humans.
Don't forget that the skin disease of the owner may also be completely unrelated to the animal's skin disease.
Diagnostic Procedures
Wood's light, skin scrapings, fungal culture, scabies trial treatment. In severe forms of suspected dermatophytosis, a biopsy and special fungal stains may prove useful for obtaining a quick diagnosis.
Question: Was the disease treated before?
Relevance
Response to previous therapy can be of tremendous help in establishing or ruling out underlying causes for the skin disease.
Initial response to recent glucocorticoid administration may not be helpful because many skin diseases improve for a short period with this symptomatic, nonspecific treatment.
Repeated response to low-dose glucocorticoid therapy suggests hypersensitivities (possibly complicated by Malassezia dermatitis caused by Malassezia pachydermatis).
Repeated response to antibiotics and glucocorticoids in combination is of little help.
Repeated partial or total response to antibiotics indicates a pyoderma usually secondary to either atopic dermatitis, food adverse reaction, hormonal disease, or another less common disorder that is suppressing the skin's immune system. In addition to antibacterial treatment, the underlying problem needs to be identified and treated to prevent recurrences.
Ask specifically how much the pet improved while receiving medication because many owners tend to judge a treatment as not helpful if it did not cure the disease.
Question: What is currently used to control fleas?
Relevance
Flea-bite hypersensitivity is the most common hypersensitivity and an extremely common skin disease in most small animal practices. If flea-bite hypersensitivity is suspected, a flea control trial should be commenced.
Details of the flea control for all animals in the household are important because in a severely allergic animal, clinical signs can be caused by a very small number of flea bites. Inconsistent or ineffective flea control can be discovered only through detailed questioning.
Many owners take questions about their flea control as an insult to their own cleanliness and hygiene. Good communication skills are a great help. I own a flea-allergic dog and routinely mention her as an example, which breaks the ice and increases the client's willingness to listen and follow my instructions.
Question: When was the last medication given?
Relevance
Recent administration of medication may affect the clinical presentation.
Long-term glucocorticoid therapy will affect the results of allergy tests--both intradermal skin testing and serum testing for allergen-specific IgE. It will also affect histopathologic findings and the results of many blood tests.
Antihistamines and short-term systemic and topical glucocorticoids (i.e., <>
Some antibiotics, such as trimethoprim-sulfonamide combinations, will affect blood concentrations of thyroxin. Others such as cephalosporins may affect the glucose readings of some urine test strips.
Remember to ask specific questions regarding heartworm prevention, vitamin supplements, or deworming which are also forms of pharmacotherapy.
Relevance
The animal's improvement in another environment indicates involvement of an environmental allergen (airborne or contact) or irritant.
Lack of improvement does not rule out these allergies, in that airborne and contact allergens may be the same in different locations (house dust mites are found almost anywhere in the world).
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