VETgirl Veterinary Continuing Education Podcasts

In today's VETgirl online veterinary continuing education podcast, we interview Dr. Dorothy Cimino Brown, Professor of Surgery at University of Pennsylvania on the use of the Coriolus versicolor mushroom, known commonly as the Yunzhi mushroom. This mushroom, which has been used in Chinese medicine for more than 2,000 years, is thought to contain immune-boosting properties from polysaccharopeptide (PSP). The specific product being used is I'm-Yunity, made by Chinese Medicine Holdings LTD (NOTE: This product is manufactured in the USA in adherence to USP c-GMP guidelines). A preliminary University of Pennsylvania pilot study that was released in 2012 evaluated 15 dogs diagnosed with hemangiosarcoma that were treated with 25, 50, and 100 mg/kg/day of I'm-Yunity. While there wasn't a statistically significant difference in survival between the three dosage groups, the median survival time was highest in the 100 mg/kg/day group, at 199 days. As as result, a second clinical trial is currently being conducted to evaluate dogs diagnosed with hemangiosarcoma. This will evaluate dogs treated with I'm-Yunity alone, dogs treated with I'm-Yunity + chemotherapy, or dogs treated with I'm-Yunity + a placebo.

In the last several years, the debate over the use of hydroxyethyl starch (HES) solutions in veterinary medicine has intensified. In human patients, HES products now have a boxed warning recommending against their use in critically ill patients, based on evidence that they contribute to coagulopathy, acute kidney injury (AKI), and increased risk of mortality.1 In veterinary patients, no studies of AKI or outcome in clinical patients receiving HES have been performed. So, Hayes et al out of Ontario Veterinary College set out to determine if HES administration was associated with outcome or AKI in canine ICU patients in a study called "Retrospective cohort study on the incidence of acute kidney injury and death following hydroxyethyl starch (HES 10% 250/0.5/5:1) administration in dogs (2007-2010)." Because many of these patients would already be considered critically ill based on their admission to the ICU, a retrospective cohort study was designed with an illness severity measure included.

In today's VETgirl online veterinary continuing education podcast, we review two studies that describe the transfusion practices used for the treatment of dogs hospitalized after trauma and for dogs undergoing splenectomy for splenic masses. These are both large retrospective studies out of Tufts University, a busy veterinary teaching hospital in Massachusetts.

In today's VETgirl online veterinary continuing education podcast, we review pulmonary hypertension (often called cor pulmonale) and the use of sildenafil (more famously known as Viagra). Pulmonary hypertension is classified is as an increase in either pre-capillary (pulmonary arterial ) or post-capillary (pulmonary venous) pulmonary resistance. In dogs, the disease occurs most commonly in older, small breed dogs as a result of chronic lung disease, chronic left-sided heart disease, heartworm infection, pulmonary thromboembolism, or left-to-right cardiac shunts (which is one of the reasons why it's so important that you treat underlying lung disease before it progresses to pulmonary hypertension!). The clinical signs of pulmonary hypertension may be indistinguishable from primary respiratory disease or congestive heart failure and includ tachypnea, cyanosis, dyspnea, increased respiratory effort, syncope, etc. Definitive diagnosis of pulmonary hypertension is made via echocardiogram by estimation of pulmonary artery pressures (typically, a dog needs to have tricuspid regurgitation to have this measured on echo). Thoracic radiographs remain an important component to the medical workup in these patients (usually performed prior to echocardiography).

In today's VETgirl online veterinary continuing education podcast, we review the important topic of the prevalence of suicide in our field. Why do veterinarians and veterinary technicians have a higher rate of suicide as compared to other fields? In a recent publication in JAVMA by Nett et al, they review the field of mental health and wellness in the veterinary profession. This is an area receiving some much-needed attention recently, due to the occurrence of some widely publicized suicides amongst veterinary professionals during the last few years. (BTW, you can check out our free VETgirl webinar on suicide by Jeannine Moga here).

In today's VETgirl online veterinary continuing education podcast, we review whether or not there is an association between hypothyroidism and dilated cardiomyopathy (DCM). Doberman Pinschers are overrepresented among canine patients diagnosed with dilated cardiomyopathy (familial/genetic), as well as those diagnosed with hypothyroidism. So the question is, is there a link? This is a very controversial topic. After all, we know that thyroid hormone plays an important role in the systolic function of the myocardium and cardiac rate and rhythm via its effect on density of beta-adrenergic receptors and their sensitivity to catecholamines. A deficiency of thyroid hormone has been associated with reduced myocardial function and alterations in cardiac conduction and heart rate thus leading to the premise that the hypothyroid state may be a metabolic etiology for dilated cardiomyopathy. Studies to date have not supported that premise.

In this VETgirl online veterinary continuing education podcast, we interview Dr. Galina Hayes, PhD, DVM, DACVECC, DACVS (Hello, letters!), Assistant Professor in Small Animal Surgery at Cornell University College of Veterinary Medicine. In her recent retrospective study performed at the Ontario Veterinary College, University of Guelph, she evaluated the incidence of acute kidney injury (AKI) and death following hydroxyethyl starch (HES 10% 250/0.5/5:1) administration in dogs (2007-2010). In this retrospective study, the authors evaluated 180 dogs receiving HES compared to 242 random dogs receiving just IV fluids. This is the first veterinary paper evaluating the risk of AKI with HES administration; however, be aware of the limitations of the study (e.g., retrospective, higher cumulative crystalloid dosing differences, higher transfusion rates, etc.). That said, before you reach for a bag of colloids, listen to this VETgirl podcast!

In today's VETgirl online veterinary CE podcast, we review a recent study titled Development of anemia, phlebotomy practices, and blood transfusion requirements in 45 critically ill cats. This study hypothesized that iatrogenic anemia occurs in hospitalized cats undergoing repeated venipuncture. This has been observed in people, especially critically ill children, and has been associated with the need for blood transfusions. Unfortunately, we know that transfusions can increase hospital cost to clients, risk of transfusion reactions, and risks of complications such as transfusion-associated circulatory overload (TACO) or transfusion-related acute lung injury (TRALI). Given that less is known about iatrogenic anemia in cats, the objectives of this study were to describe the incidence and development of anemia, to document phlebotomy practices and transfusion requirements in these cats, and to evaluate the association between these factors and duration of hospitalization and outcome in critically ill cats.

In today's VETgirl online veterinary CE podcast, we review the use of antivenom in dogs. Is it worth the $500/bottle? How many bottles should we use? Is it necessary in all cases? So, we interview Dr. Daniel Foy, DACVIM, DACVECC, who published a study called "Retrospective evaluation of the effect of antivenom administration on hospitalization duration and treatment cost for dogs envenomated by Crotalus viridis: 113 dogs (2004–2012)." This was a retrospective study looking at a large case population (over 100 dogs) who were envenomated with Crotalus viridis, or more commonly known as the prairie rattlesnake (which isn't as bad as other types of Crotalid species). In this study, it appeared that the use of antivenom did not positively affect outcome or duration of hospitalization, and actually increased costs! So, test your envenomation knowledge here in today's VETgirl podcast.

In today's VETgirl online veterinary continuing education podcast, we review the usefulness of measuring iron levels in dogs with systemic inflammatory response syndrome (SIRS). Now, you probably don't think you see SIRS or septic cases, but you do. SIRS is a result of overstimulation of the inflammatory cascade (with secondary release of inflammatory mediators). SIRS can be seen due to thermal injury (e.g., heat stroke, burns), immune-mediated disease, etc. and can be seen with neoplasia, pancreatitis, trauma, infectious disease, etc. The definition of SIRS is very loose, unfortunately and includes two of the following criteria:

Do you treat patients with septic peritonitis in your clinic? If you do, do you agonize over them for the first few days after surgery, worried that they will require a second surgery due to recurrence (Is this dog going to perf!)? Have you thought about what factors might put these patients at risk for recurrence?Sponsored By: Royal Canin

What's your favorite way of giving furosemide to the critically ill, fragile, dyspneic congestive heart failure patient? Is it worth putting in an IV catheter just to give furosemide IV? (No). Does it matter what route you give it?

How do you like to treat blocked cats in your practice? Do you have an opinion about the use of decompressive cystocentesis (DC)? If you aren’t familiar with it, this procedure involves performing cystocentesis in cats with urethral obstruction (UO) prior to placement of a urinary catheter. Some argue that it makes patients comfortable more quickly by relieving bladder distention, and also makes it easier to pass a urinary catheter due to reduced back pressure. Others feel strongly that decompressive cystocentesis increases the risk of bladder rupture and uroabdomen.

In today's VETgirl online veterinary CE podcast, we interview Dr. Soren Boysen, DACVECC from the University of Calgary and Dr. Jantina McMurray on their recent publication on the use of AFAST and TFAST ultrasound in non-trauma patients presenting to the emergency services. In this prospective study, the looked at 100 dogs and cats and found that 33% had free fluid identified on presentation. In unstable or dyspneic patients, 75% had evidence of effusion. So, if you have an ultrasound machine, are you using it enough in your clinic and patients?

In this VETgirl online veterinary CE podcast, we review ventricular septal defects (VSDs) in dogs and cats. VSDs are defined as an opening or communication in the interventricular septum due to defects in closure or alignment of the septum during fetal development. VSDs are a regularly identified form of congenital heart disease in animals, albeit less common than the incidence of VSDs in humans. VSDs are subclassified based on anatomic location and include the following varieties:

In this VETgirl online veterinary continuing education podcast, we interview Dr. Erica Reineke, DACVECC, an Assistant Clinical Professor in Emergency Critical Care at University of Pennsylvania School of Veterinary Medicine on a recent paper that she published. In this JVECC publication, she evaluates systolic blood pressure measurement based on physical examination as compared to Doppler analysis. In this prospective, observational study, the authors evaluated 102 cats that presented to the emergency services and evaluated the femoral and dorsal pedal pulse to predict systolic blood pressure in cats. House officers (e.g., interns, residents) evaluated pulse quality and defined it as either: strong, moderate, poor, or absent. A concurrent SBP was also performed. What'd they find?

In today's VETgirl online veterinary continuing education Real-Life Rounds podcast, we review the use of intravenous lipid emulsion (ILE) in veterinary medicine. Should we veterinarians be using it with every poisoning or toxicology case? Listen to find out more!

In today's VETgirl online veterinary continuing education podcast, we interview Dr. Raegan Wells, DACVECC, Director of Medical Management at Blue Pearl in Phoenix, Arizona. In this veterinary podcast, she reviews a recent case report published in JVECC on the use of intravenous lipid emulsion for a synthetic marijuana toxicity case she saw in a dog. Learn how to treat THC (i.e., the real and synthetic case poisonings!), what signs to look for, and whether or not the use of intravenous lipid emulsion would benefit your patient. When in doubt, contact the ASPCA Animal Poison Control Center for life-saving advice!

In today's VETgirl online veterinary CE podcast, we review a common presenting complaint to emergency veterinarians: hemoabdomen. Most of us know that the majority of spontaneous hemoperitoneums are due to bleeding splenic masses (malignant or not), and if you’re dealing with a hemangiosarcoma, the long term prognosis isn’t great. But have you thought about what factors might be associated with a worse perioperative outcome (for example, from the time of admission for the bleed through surgery to discharge) in this critically ill, emergent population?

In this VETgirl online veterinary CE podcast, we review TRALI (again, as it's super important!). Have you ever heard of TRALI? The acronym stands for transfusion-related acute lung injury, and is a type of acute lung injury (ALI) recognized in human patients receiving transfusions. In people, this syndrome occurs either immediately after transfusion (TRALI) or within 6-72 hours of transfusion (delayed TRALI). It is characterized by an acute onset of clinical signs, hypoxemia and bilateral lung infiltrates in the absence of heart disease, and no ALI before the transfusion. TRALI can affect between 5-25% of human ICU patients receiving transfusions, and can be life-threatening. In veterinary patients, the condition is termed VetALI and is characterized by similar criteria, including:

In this VETgirl online veterinary CE podcast, we review cocaine toxicosis in dogs. Have you ever seen a patient with cocaine toxicosis in your practice? Do you know how to recognize one? What do you tell owners about prognosis with treatment?

In this VETgirl online veterinary CE podcast, we review the use of heparin versus saline flushes. Which is better?

In this VETgirl online veterinary CE podcast, we review whether mixing dog food with activated charcoal works. After all, it's usually easier to get a dog to eat the charcoal if you mix it with some palatable food with poisoning cases, right? Well, have you ever wondered about the effect of that food on the adsorptive capacity of the charcoal? Will it decrease its efficacy in terms of helping to eliminate that toxin from your patient’s system?

In this VETgirl online veterinary CE podcast, we review the association between previous splenectomy and gastric-dilatation volvulus (GDV) in dogs. Picture this scenario: it’s late into your overnight emergency shift, and you’re cutting a hemoabdomen in a middle age, large breed dog. You found a bleeding splenic mass and removed it, and now you’re trying to decide if you should do a prophylactic gastropexy. Sounds familiar, right? Well, there are actually some theories out there that suggest splenectomy might increase a patient’s risk for GDV, so considering that pexy might be smart. Possible reasons for this increased risk include the void created by removal of the spleen (especially if it was enlarged) leading to increased gastric mobility, or stretching of the ligaments in the cranial abdomen due to a splenic mass, torsion, or previous episodes of gastric dilatation (without volvulus). But, regardless of these theories, previous studies have been mixed, so how are you going to decide if you should pexy this dog that’s on the table?

In this VETgirl online veterinary continuing education podcast, we interview Dr. David Maggs, BVSc, DACVO, Professor of Ophthalmology at the UC Davis School of Veterinary Medicine on the use of lysine supplementation in cats with herpesvirus. Does it work? A recent paper adamantly debunked its use (Boll et al), and veterinarians are left wondering - should I be recommending this (safe and benign) medication? When in doubt, consider reaching for topical antivirals instead...

diagnostic-imaging-radiologyIn today's VETgirl online veterinary continuing education podcast, we interview Dr. Anthony Fischetti, DACVR, Department Head of Radiology at the Animal Medical Center in New York. Here, this veterinary podcast reviews some great tips on "FAST" ultrasound to what type of probe you need to how to avoid some common mistakes when interpreting radiographs!

How do you measure blood pressure non-invasively in your patients? Do you use Doppler? Oscillometric? Do you perform the measurement with your patient sitting or standing? Do you always do it the same way? Have you ever given it much thought? Well, in today's VETgirl online veterinary CE podcast, we review the effect of body position on blood pressure measurement in dogs.

In this VETgirl online veterinary CE podcast, we review C-reactive protein levels and whether or not they can be useful in managing your parvovirus cases.

In this VETgirl online veterinary CE podcast, we review the use of pimobendan in dogs with myxomatous mitral valve degeneration (MMVD). Pimobendan (commonly known as Vetmedin in the United States) is a phosphodiesterase III inhibitor and calcium sensitizer. It is commonly used as a therapy for congestive heart failure and is often referred to as an “inodilator” due to its positive inotropic and peripheral vasodilatory mechanisms of action.

In this VETgirl online veterinary CE podcast, we review a common plant toxicosis seen in both dogs and cats: insoluble calcium oxalate containing plants. We'll also review the less common plant toxicant soluble calcium oxalate containing plants and discuss the difference between the two types.

In this VETgirl online veterinary CE podcast, we review patent ductus arteriosus (PDA). Left-to right patent ductus arteriosus (PDA) is the most common congenital heart defect in dogs. PDA also occurs in cats but with much lower incidence. If PDA is left untreated, it results in left-sided volume cardiac overload, with a high incidence of congestive heart failure (CHF) within the first year of life. Definitive treatment usually carries a good prognosis and consists of attenuation of flow across the PDA by either surgical ligation (e.g., via thoracotomy) or placement of occlusion devices (e.g., such as coils, plugs or occluders) from within the vascular space via a transcatheter/transvascular approach. Both methods are highly successful in dogs, with transvascular methods preferred as they are less invasive and have a lower rate of major complications. So what about cats? Unfortunately, these approaches can both be more difficult in cats due to their small size. To date, minimal data exists in veterinary literature about correction of PDAs versus medical management in cats.

In this VETgirl online veterinary CE podcast, we review Transfusion Related Acute Lung Injury (TRALI). In veterinary medicine, the use of transfusions has become more prevalent, particularly in the field of emergency and critical care. Transfusion medicine is important to help improve oxygen delivery, provide coagulation factors, and provide hemoglobin. That said, the benefits of transfusions must outweigh the risks - albeit rare - from the product itself.

In this VETgirl online veterinary CE podcast, we review updates in treatment for canine parvovirus (CPV). As parvovirus can result in severe dehydration, secondary hypovolemia, hypoglycemia, sepsis, and DIC, rapid identification, recognition of clinical signs, and treatment should occur to ensure the best outcome. In this Part 2 of 2 podcasts, we review the clinicopathologic results of parvovirus and focus on treatment of the critically ill pediatric patient.

In this VETgirl online veterinary CE podcast, we review updates in treatment for canine parvovirus (CPV). As parvovirus can result in severe dehydration, secondary hypovolemia, hypoglycemia, sepsis, and DIC, rapid identification, recognition of clinical signs, and treatment should occur to ensure the best outcome. In this Part 1 of 2 podcasts, we review the etiology, pathophysiology, and clinical signs of parvovirus.

In today’s VETgirl online veterinary CE podcast, we review the significance of pulmonary hypertension in dogs with myxomatous mitral valve disease (or what we’ll call MMVD from now on). Pulmonary hypertension (PH) is thought to commonly occur in dogs with MMVD due to passive elevations in pulmonary venous and capillary pressures; this can progress to pulmonary arterial vasoconstriction and remodeling of pulmonary vasculature (with the latter considered an irreversible stage).

In today's VETgirl online veterinary CE podcast, we interview Dr. Deborah Silverstein, DACVECC, Associate Professor of Critical Care at the University of Pennsylvania's School of Veterinary Medicine. (She's also one of the co-editors for the fantastic book Small Animal Critical Care Medicine). She talks about all the scary acronyms of critical care: SIRS, MODS, sepsis, and septic shock. So, if you don't think you see Systemic Inflammatory Response Syndrome (SIRS) or multi-organ dysfunction syndrome (MODS), think again. Tune in to learn what you need to do to treat your critically ill patient.

In today's VETgirl online veterinary CE podcast, we review Herring et al's recent publication in Journal of Veterinary Emergency Critical Care called "Intravenous lipid emulsion therapy in three cases of canine naproxen overdose." Naproxen, an OTC or prescription human NSAID, has a narrow margin of safety in dogs and cats. As little as 5 mg/kg can result in gastrointestinal distress (e.g., vomiting, diarrhea, etc.) while doses > 10-25 mg/kg can result in acute kidney injury (AKI). Doses > 50 mg/kg can result in central nervous system signs (e.g., tremors, coma, etc.).

Who likes treating dyspneic cats?

In this VETgirl online veterinary CE podcast, we interview Dr. Kelly Hall on what the Veterinary Committee on Trauma (VetCOT) Veterinary Trauma Center (VTC) network is. The goal of VETCOT is to create a network of lead hospitals that seed development of trauma systems. There are three different levels (1 through III) of Veterinary Trauma Centers. This is different from VECCS Facility Certification. These hospitals will work collaboratively to define standards of care and disseminate information that improves trauma patient management efficiency and outcome. Find out more about VetCOT here!

In this VETgirl online veterinary CE blog podcast, we interview Dr. Allison Sande, DACVIM, DACVECC on her JVECC publication on acute liver failure in dogs and cats. What are the underlying causes of acute hepatic necrosis in dogs and cats, and what is the overall treatment and prognosis? Learn more in this VETgirl podcast!

Hypertrophic cardiomyopathy (HCM) is the most common form of heart disease in cats and carries a particularly poor prognosis for those cats with HCM that experience aortic thromboembolism (ATE), congestive heart failure (CHF), and distortion of cardiac chamber dimensions and function. Assessment of cardiac biomarkers such as cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NTproBNP) in various disease states has increased in human and veterinary medicine but little prognostic data is available for these biomarkers with HCM in cats. Both cardiac biomarkers appear to carry prognostic value in humans with HCM. So, Borgeat et al out of Royal Veterinary College wanted to investigated whether a single measurement of NTproBNP or cTnI would provide such value in cats with HCM in a study called Plasma Cardiac Troponin I Concentration and Cardiac Death in Cats with Hypertrophic Cardiomyopathy.

In today's VETgirl online veterinary CE podcast blog, we interview Dr. Lindsey Nielsen, DACVECC on her study that she conducted retrospectively at Angell Animal Medical Center on the the use of fenoldopam. Fenoldopam is a selective D1 receptor partial agonist used to help attempt to vasodilate the renal vessels in acute kidney injury (AKI) patients. So, does fenoldopam help increase urine output and improve the outcome with AKI (No.)? Here, a review of AKI, fluid therapy, dopamine, mannitol, or other unique drugs like fenoldopam.

In this VETgirl online veterinary continuing education podcast, David Liss, RVT, discusses how to best utilize your veterinary technician in helping you manage emergencies in daily practice. Are you not taking the time to do "doctor things" during an emergency? Check out this podcast to learn what you can do to improve your efficiency thanks to the help of your team!

In this VETgirl podcast, we review the clinical utility of Holter monitoring in dogs with advanced myxomatous mitral valve disease with or without a history of syncope.

In this VETgirl online veterinary CE podcast, we interview Dr. Lauren Sullivan, DACVECC, an Assistant Clinical Professor at CSU. She reviews this common infectious disease affecting immunocomprised, poorly vaccinated puppies, and discusses etiology, clinical signs, treatment, and some new updates in veterinary medicine. In a recent study at CSU, the use of outpatient therapy with canine parvovirus can still yield a good prognosis. Check out this VETgirl podcast for more information and get your street medicine on!

In this VETgirl online veterinary continuing education podcast, Dr. Lisa Radosta, DACVB from Florida Veterinary Behavior Service discusses litterbox size preference in domestic cats. As inappropriate urination is the #1 feline behavioral disorder, help your clients by educating them on what exact size box is appropriate for the average-sized cat.

In today's VETgirl podcast, we review the importance of performing a venous blood gas in the vomiting patient. Why? Because when we see a hypochloremic, hypokalemic metabolic alkalosis, we should be ruling out an obstructive gastrointestinal (GI) foreign body. Previously, the presence of a metabolic alkalosis has been associated with a upper GI (e.g., pyloric) foreign body. Why? Because of protracted vomiting and loss of chloride, which deletes the body of an anion. In order to maintain electroneutrality, when a sodium (Na+) moves, a negatively charged anion must exchange with it. While this is typically chloride, if the body is chloride deplete, it absorbs bicarbonate (HCO3-) instead, resulting in the classic metabolic alkalosis.

In today's VETgirl podcast, we review feline arterial thromboembolism (FATE) - otherwise known as arterial thromboembolism (ATE). FATE is commonly associated with underlying cardiomyopathy and most commonly affects peripheral limbs. The high morbidity and mortality thus carry a generally poor prognosis, with euthanasia a frequent outcome. Cats may present with concurrent congestive heart failure (CHF). For the minority of cats who achieve partial or complete resolution of ATE, the likelihood of recurrent ATE is high.

In this VETgirl podcast, Dr. Lisa Powell, DACVECC reviews a study out of Tufts University assessing the time of antimicrobial administration in the treatment of septic peritonitis and overall survival. Does it matter when you reach for a vial of antibiotics in your emergent or critically ill patients? The goals of this study were to determine whether creation and implementation of a canine abdominal sepsis protocol decreased time to antimicrobial administration in dogs with septic peritonitis.

In today's VETgirl online veterinary CE podcast, Dr. Anusha Balakrishnan from the Ohio State University College of Veterinary Medicine reviews how to handle the respiratory emergency in dogs and cats. In this 30-minute podcast, she reviews approach, signalment, oxygen therapy, general handling, differential diagnoses, pharmacological interventions, and overall treatment. So, don't get tachypneic with your dyspneic patients and get all your tips here!