Compendium
                     CompendiumVet.com | Peer Reviewed | Listed in MEDLINE      Vol 31(6) June 2009




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Everycat
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June
                                                                                                      2009 Vol 31(6)
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June
2009 Vol 31(6)
                                          CompendiumVet.com | Peer Reviewed | Listed in MEDLINE


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Coming Events                                                          Canadian News
July 16
Ontario Veterinary Medical As...
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                                                                                  Each CE article is accredited for 3 co...
Gentle
           on his ears




The Latest Generation in Otitis Externa Treatment.
Mometasone furoate
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Letters
Feline Hyperesthesia Syndrome                                                       Understanding
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What do dogs who takee
VETORYL (trilostane)
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WEB EXCLUSIVES                     June 2009        Vol 31(6)
VETORYL Capsules (trilostane)
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30 mg and...
Editorial
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  1. 1. Compendium CompendiumVet.com | Peer Reviewed | Listed in MEDLINE Vol 31(6) June 2009 3 CE Contact Hours CONTI N U I NG EDUCATION FOR VETERI NARIANS ® FREE CE Feline Obesity Clinical Recognition and Management NEW SERIES A AAFP Retrovirus Guidelines al y rn lit * Surgical Views ou a s! Ve e ium yJ u ar l Q Laparoscopic Cryptorchidectomy m O nd rin l te ra pe Understanding Behavior al v m # om Addi B h i S i Adding Behavior Services ni n C lA i al 1 rS d fo te Ra
  2. 2. Everycat needs calicivirus protection. Everycat deserves CaliciVax. Bivalent for broader protection. The AAFP recommends calicivirus vaccine as a core antigen for all cats.1 Bivalent CaliciVax TM cross-neutralizes a broader range of strains than an older, first-generation vaccine.2 Multiple combinations make it easy to update your protocol and customize protection for every patient. Contact your Fort Dodge Animal Health representative today and ask for the bivalent protection of CaliciVax. Here’s how CaliciVax compares to a first-generation vaccine. 2 More traditional strains cross-neutralized 100– 75– 70% PERCENT 50– 25– 26% 0 CaliciVax Single-strain vaccine 1. 2006 American Association of Feline Practitioners Feline Vaccine Advisory Panel Report. JAVMA, Vol. 229, No. 9, Nov. 1, 2006. 2. Data on file, Fort Dodge Animal Health. Comparison among Fort Dodge vaccines. ©2009 Fort Dodge Animal Health, a division of Wyeth. CaliciVax ™
  3. 3. June 2009 Vol 31(6) CompendiumVet.com | Peer Reviewed | Listed in MEDLINE EXECUTIVE EDITOR Tracey L. Giannouris, MA 800-426-9119, ext 52447 | tgiannouris@vetlearn.com PUBLISHED BY MANAGING EDITOR Kirk McKay 800-426-9119, ext 52434 | kmckay@vetlearn.com Subscription inquiries: SENIOR EDITOR 800-426-9119, option 2. Robin A. Henry Subscription rate: $79 for 1 800-426-9119, ext 52412 | rhenry@vetlearn.com year; $143 for 2 years; $217 for 3 years. Canadian and ASSOCIATE EDITOR Mexican subscriptions (sur- Chris Reilly face mail): $95 for 1 year; 800-426-9119, ext 52483 | creilly@vetlearn.com $169 for 2 years; $270 for 3 years. Foreign subscriptions ASSISTANT EDITOR (surface mail): $175 for 1 Benjamin Hollis Published monthly by Veteri- year; $275 for 2 years; $425 800-426-9119, ext 52489 | bhollis@vetlearn.com nary Learning Systems, a for 3 years. Payments by division of MediMedia, check must be in U.S. funds VETERINARY ADVISER 780 Township Line Road, drawn on a U.S. branch of a Dorothy Normile, VMD, Chief Medical Officer Yardley, PA 19067. Copyright U.S. bank only; credit cards 800-426-9119, ext 52442 | dnormile@vetlearn.com © 2009 Veterinary Learning are also accepted. Change Systems. All rights reserved. of Address: Please notify SENIOR ART DIRECTOR Printed in the USA. No part of the Circulation Department Michelle Taylor this issue may be reproduced 45 days before the change 267-685-2474 | mtaylor@vetlearn.com in any form by any means is to be effective. Send your without prior written permis- new address and enclose an ART DIRECTOR sion of the publisher. address label from a recent David Beagin issue. Selected back issues 267-685-2461 | dbeagin@vetlearn.com Printed on acid-free paper, are available for $15 (United effective with volume 29, States and Canada) and $17 OPERATIONS issue 5, 2007. (foreign) each (plus postage). Marissa DiCindio, Director of Operations 267-685-2405 | mdicindio@vetlearn.com Periodicals postage paid at Indexing: Compendium: Con- Morrisville, PA, and at addi- tinuing Education for Veteri- Elizabeth Ward, Production Manager tional mailing offices. narians® is included in the 267-685-2458 | eward@vetlearn.com international indexing cover- Postmaster: Send address age of Current Contents/ Christine Polcino, Traffic Manager changes to Compendium: Agriculture, Biology and 267-685-2419 | cpolcino@vetlearn.com Continuing Education for Environmental Sciences (ISI); Veterinarians®, 780 Township SALES & MARKETING Line Road, Yardley, PA 19067. SciSearch (ISI); Research Joanne Carson, National Account Manager Canada Post international Alert (ISI); Focus On: Veteri- nary Science and Medicine 267-685-2410 | Cell 609-238-6147 | jcarson@vetlearn.com publications mail product (ISI); Index Veterinarius (Canadian distribution) sales Boyd Shearon, Account Manager agreement no. 40014103. (CAB International, CAB 913-322-1643 | Cell 215-287-7871 | bshearon@vetlearn.com Return undeliverable Canadian Abstracts, CAB Health); and Agricola (Library of Congress). addresses to MediMedia, Lisa Siebert, Account Manager PO Box 7224, Windsor, ON Article retrieval systems 913-422-3974 | Cell 215-589-9457 | lsiebert@vetlearn.com N9A 0B1. Printed in USA. include The Genuine Article (ISI), The Copyright Clear- CLASSIFIED ADVERTISING ance Center, Inc., University Compendium: Continuing Liese Dixon, Classified Advertising Specialist Education for Veterinarians® Microfilms International, and 800-920-1695 | classifieds@vetlearn.com | www.vetclassifieds.com Source One (Knight-Ridder (ISSN 1940-8307) Information, Inc.). Yearly EXECUTIVE OFFICER author and subject indexes Derrick Kraemer, President for Compendium are pub- lished each December. CUSTOMER SERVICE 800-426-9119, option 2 | info.vls@medimedia.com CompendiumVet.com 249
  4. 4. June 2009 Vol 31(6) CompendiumVet.com | Peer Reviewed | Listed in MEDLINE EDITORIAL BOARD Anesthesia Internal Medicine Nora S. Matthews, DVM, DACVA Dana G. Allen, DVM, MSc, DACVIM AMERICAN Texas A&M University Ontario Veterinary College BOARD OF Cardiology Internal Medicine and Emergency/ VETERINARY Bruce Keene, DVM, MSc, DACVIM Critical Care PRACTITIONERS North Carolina State University Alison R. Gaynor, DVM, DACVIM (Internal Medicine), DACVECC (ABVP) REVIEW Clinical Chemistry, Hematology, North Grafton, Massachusetts BOARD and Urinalysis Betsy Welles, DVM, PhD, DACVP Nephrology Kurt Blaicher, DVM, DABVP Auburn University Catherine E. Langston, DVM, ACVIM (Canine/Feline) Dentistry Animal Medical Center Plainfield Animal Hospital Gary B. Beard, DVM, DAVDC New York, New York Plainfield, New Jersey Auburn University Neurology Canine and Feline Medicine EDITOR IN CHIEF R. Michael Peak, DVM, DAVDC Curtis W. Dewey, DVM, MS, DACVIM The Pet Dentist—Tampa Bay Veterinary (Neurology), DACVS Eric Chafetz, DVM, DABVP Douglass K. Macintire, Cornell University Hospital for Animals Dentistry (Canine/Feline) DVM, MS, DACVIM, DACVECC Largo, Florida Vienna Animal Hospital Oncology Department of Clinical Sciences Emergency/Critical Care and Ann E. Hohenhaus, DVM, DACVIM Vienna, Virginia College of Veterinary Medicine Respiratory Medicine (Oncology and Internal Medicine) Canine and Feline Medicine Auburn University, AL 36849 Lesley King, MVB, MRCVS, DACVECC, Animal Medical Center DACVIM New York, New York Henry E. Childers, DVM, University of Pennsylvania DABVP (Canine/Feline) Gregory K. Ogilvie, DVM, DACVIM Endocrinology and Metabolic Disorders (Internal Medicine, Oncology), Cranston Animal Hospital Marie E. Kerl, DVM, ACVIM, ACVECC DECVIM-CA (Oncology) Cranston, Rhode Island University of Missouri-Columbia CVS Angel Care Cancer Center Canine and Feline Medicine EXECUTIVE Epidemiology and Special Care Foundation for Companion Animals ADVISORY Philip H. Kass, DVM, MPVM, MS, PhD, Carlsbad, California David E. Harling, DVM, BOARD DACVPM DABVP (Canine/Feline), University of California, Davis Ophthalmology DACVO MEMBERS David A. Wilkie, DVM, MS, DACVO Reidsville Veterinary Hospital Exotics Avian The Ohio State University Reidsville, North Carolina Behavior Canine and Feline Medicine, Thomas N. Tully, Jr, DVM, MS, DABVP Parasitology Sharon L. Crowell-Davis, (Avian), ECAMS Ophthalmology Byron L. Blagburn, MS, PhD DVM, PhD, DACVB Louisiana State University Auburn University The University of Georgia Jeffrey Katuna, DVM, DABVP Reptiles David S. Lindsay, PhD Douglas R. Mader, MS, DVM, DABVP (DC) Wellesley-Natick Veterinary Virginia Polytechnic Institute Hospital Dermatology Marathon Veterinary Hospital and State University Craig E. Griffin, DVM, Marathon, Florida Natick, Massachusetts DACVD Pharmacology Canine and Feline Medicine Small Mammals Animal Dermatology Clinic Katrina L. Mealey, DVM, PhD, DACVIM, Karen Rosenthal, DVM, MS, DABVP DACVCP Robert J. Neunzig, DVM, San Diego, California (Avian) Washington State University University of Pennsylvania DABVP (Canine/Feline) Rehabilitation and Physical Therapy The Pet Hospital Wayne S. Rosenkrantz, Feline Medicine Bessemer City, North Carolina Darryl Millis, MS, DVM, DACVS DVM, DACVD Michael R. Lappin, DVM, PhD, University of Tennessee Canine and Feline Medicine Animal Dermatology Clinic DACVIM (Internal Medicine) Colorado State University Tustin, California Surgery Compendium is a Margie Scherk, DVM, DABVP Philipp Mayhew, BVM&S, MRCVS, (Feline Medicine) DACVS refereed journal. Articles Nutrition Cats Only Veterinary Clinic Columbia River Veterinary Specialists published herein have Kathryn E. Michel, DVM, Vancouver, British Columbia Vancouver, Washington MS, DACVN been reviewed by at least University of Pennsylvania Gastroenterology C. Thomas Nelson, DVM two academic experts on Debra L. Zoran, DVM, MS, PhD, Animal Medical Center the respective topic and DACVIM (Internal Medicine) Anniston, Alabama Surgery Texas A&M University by an ABVP practitioner. Elizabeth M. Hardie, Toxicology Infectious Disease Tina Wismer, DVM, DABVT, DABT Any statements, claims, or product DVM, PhD, DACVS Derek P. Burney, PhD, DVM ASPCA National Animal Poison Control endorsements made in Compendium North Carolina State Gulf Coast Veterinary Specialists Center are solely the opinions of our authors and advertisers and do not necessarily University Houston, Texas Urbana, Illinois reflect the views of the Publisher or Editorial Board. 250 CompendiumVet.com
  5. 5. Coming Events Canadian News July 16 Ontario Veterinary Medical Association: Career Planning for Associate Veterinarians & Potential Practice Owners Canadian Government Invests in Ontario Veterinary Medical Association Milton, Ontario This course will present the benefits and Western College of Veterinary Medicine downsides of owning a practice as well as T he government of Canada is invest- The construction of a two-story addi- the practical aspects of practice ownership. ing $2.7 million in the infrastructure tion and basement will add 3000 m2 of Web www.ovma.info/Meetings/ of the University of Saskatchewan’s additional space to the diagnostics facil- August 8–13 Western College of Veterinary Medicine ity. Once completed, the centre will World Association for the Advancement (WCVM). The funding, coming from the be a major western Canadian hub for of Veterinary Parasitology: 22nd Canadian Western Economic Diversifica- veterinary diagnostics services, ani- International Conference Calgary, Alberta tion program, will be used on upgrades mal health research, and specialized This conference will discuss current issues to the large animal clinic and the diag- training in diagnostic pathology, virol- in parasitology. nostics laboratory at the college. ogy, bacteriology, immunology, and Web waavp.org The upgraded facilities will make a range of biomedical sciences. September 9 the college, province, and country “The expansion of the college’s Calgary Academy of Veterinary more competitive, according to Minister diagnostics area and the renovation of Medicine: Ophthalmology of State Lynne Yelich. “Investments our large animal clinical services will Clara Christie Theatre, Health Sciences such as these will lead to new diag- provide our staff and students with University of Calgary, Alberta This seminar will offer 1.5 hours of scientific nostic tests that will protect Canada’s specialized, biosecure facilities where CE and will be presented by Dr. Cheryl Cullen. livestock industry and the health and they’ll have access to a full range of Phone 403-863-7160 safety of Canadians, their families, and new technologies,” says WCVM Dean E-mail info@cavm.ab.ca communities.” Dr. Charles Rhodes. Web cavm.ab.ca/ce_calendar.html September 15 Toronto Academy of Veterinary Medicine: Animal Health Network Announced Update on Clinical Gastroenterology T Dave and Buster’s he Canadian Food Inspection Agency our ability to understand and respond Toronto, Ontario and the Atlantic Veterinary College to animal health and zoonotic disease This seminar will provide an update on (AVC) at the University of Prince challenges in a world of ever-changing gastrointestinal disorders of cats and Edward Island have joined together risks,” said Dr. Brian Evans, chief vet- dogs, with an emphasis on diagnosis and treatment. It will offer 5.5 CE credits. in a $1.2-million partnership to create erinary officer of Canada. Phone 800-670-1702 the Canadian Regulatory Veterinary Web tavm.org Epidemiology Network. This network will link the five Canadian veterinary SPREAD YOUR GOOD NEWS October 13 Have any interesting news to Toronto Academy of Veterinary colleges and enhance animal health expertise by contributing to research share? Send it in! We would like Medicine: Early Resuscitation and Stabilization of the Emergency Patient and training programs. In addition to to provide more recognition of Dave and Buster’s veterinarians doing great things in strengthening Canada’s animal disease Toronto, Ontario their professional or personal lives. This seminar will focus on practical prevention and control efforts, the pro- If you have news about yourself or emergency management using case gram will also help meet national and a colleague or about some other examples. It will offer 5.5 CE credits. international demands for animal and newsworthy topic that would be of Phone 800-670-1702 veterinary health experts. interest to others in the profession, Web tavm.org The initial phase of the project will send it (along with a picture if you October 18 establish a research chair in regulatory have one) to: Calgary Academy of Veterinary veterinary epidemiology at the AVC as Medicine: Hematology Canadian News well as related graduate positions. The c/o Veterinary Learning Systems Clara Christie Theatre, Health Sciences network will be led by the Centre for 780 Township Line Road University of Calgary, Alberta This seminar will offer 6 hours of scientific Veterinary Epidemiological Research at Yardley, PA 19067 USA , CE and be presented by Dr. Marjorie Brooks. the AVC, which is considered one of E-MAIL editor@CompendiumVet.com Phone 403-863-7160 the leading centres for animal health E-mail info@cavm.ab.ca FAX 800-556-3288 epidemiologic research in the world. WEB CompendiumVet.com Web cavm.ab.ca/ce_calendar.html “This network will further strengthen CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 251
  6. 6. E Each CE article is accredited for 3 contact hours by June 2009 Vol 31(6) CE A Auburn University College of Veterinary Medicine. CompendiumVet.com | Peer Reviewed | Listed in MEDLINE Features 258 Understanding 284 Feline Obesity: Clinical FREE Behavior t Recognition and Management CE Incorporating Behavioral ❯❯ Debra L. Zoran Medicine Into General Obesity is a common problem in cats that is compounded by most cats’ sedentary Practice lifestyles and many owners’ feeding tech- ❯❯ Lisa Radosta niques. Recognition of the risk factors for Learn how—and why—to obesity and early education of owners to include basic behavioral prevent excessive weight gain are crucial to medicine into your day- feline health. Further information on feline to-day practice. obesity is available on CompendiumVet.com. 264 Feline Focus NEW SERIES 2008 Feline Retrovirus s Management Guidelines In the debut of this quarterly series devoted to feline medicine, the American Association of Feline Practitioners shares an abridged version of its most recent guidelines. 274 Surgical Views Laparoscopic and Laparoscopic-Assisted Cryptorchidectomy in Dogs and Cats ❯❯ Philipp Mayhew Surgical removal is the standard of care for cryptorchid testicles. Laparoscopy can help reduce incision sizes and postoperative pain in these patients. Watch videos of some aspects of these procedures on CompendiumVet.com. Cover image © 2009 Carol Adams, Lone Oak Veterinary Clinic On the Cover Departments This radiograph, obtained by Carol Adams, DVM, 254 Letters 295 Index to Advertisers of Lone Oak Veterinary Clinic in Visalia, California, is from an 8-year-old cat that weighed 19 lb. The 256 CompendiumVet.com 295 Market Showcase excessive weight placed undue stress on the cat’s skeleton. 257 Editorial: Feline Focus 295 Classified Advertising ❯❯ Margie Scherk *2009 PERQ/HCI FOCUS® Veterinary Study of Total Companion Animal Veterinarians, in comparison to ratings for each publi- 294 Product Forum 296 In Memory: Anna Worth cation, by that publication’s readers. 252 Compendium: Continuing Education for Veterinarians®
  7. 7. Gentle on his ears The Latest Generation in Otitis Externa Treatment. Mometasone furoate 1 Clotrimazole Malassezia pachydermatis Gentamicin 2 Once-a-day for ease of compliance ® Mometamax Malassezia pachydermatis) Pseudomonas P. aeruginosa Enterococcus faecalis, Proteus mirabilis See Page 254 for Product Information Summary 1. Reeder CJ, Griffin CE, Polissar NL, et al. Comparative adrenocortical suppression in dogs with otitis externa following topical otic administration of four different glucocorticoid-containing medications. Vet Therap. 2008;9:111-121. 2. Rubin J, Walker RD, Blickenstaff K, Bodies-Jones S, Zhao S., Antimicrobial resistance and genetic characterization of fluoroquinolone resistance of Pseudomonas aeruginosa isolated from canine infections., Vet microbiol. Mometamax is a registered trademark of Intervet Inc. or an affiliate. 2008 Mar 4; [Epub ahead of print] © 2009 Intervet Inc. All rights reserved. SPAH-MO-96
  8. 8. Letters Feline Hyperesthesia Syndrome Understanding Behavior Feline Hyperesthesia Syndrome* I read with interest the March 2009 Understanding About This Column Behavior problems are a signifi- ❯❯ John Ciribassi, DVM, DACVB Chicagoland Veterinary Behavior Consultants Carol Stream, Illinois cant cause of death (euthanasia) Behavior article on feline hyperesthesia syndrome in companion animals. While most veterinary practices are necessarily geared toward the medical aspect F eline hyperesthesia syndrome (FHS) is known by several names, including rolling skin disease, neurodermatitis, neuritis, psychomotor epilepsy, and pru- ritic dermatitis of Siamese.1,2 As evidenced by these names and by the use of of care, there are many opportuni- the term syndrome, FHS is not characterized as having a single etiology. In fact, ties to bring behavior awareness it is often a diagnosis of exclusion. The differential diagnosis for FHS includes into the clinic for the benefit of diseases related to the fields of dermatology, neurology, and behavior. Only after (FHS), a poorly understood clinical entity. To me, it is the pet, the owner, and ourselves. This column acknowledges the importance of behavior as part of veterinary medicine and speaks conditions relating to skin and the nervous system have been ruled out can this condition be labeled a behavior disorder. Signalment FHS can occur in cats of any age, but it is commonly seen in cats aged 1 to 5 practically about using it effectively years. Males and females are equally affected. While all breeds can be affected, plausible that some cats with clinical signs compatible in daily practice. Siamese, Burmese, Persian, and Abyssinian cats are more commonly afflicted.3 Clinical Signs As indicated by the name rolling skin disease, affected cats often show rippling or rolling skin along the lum- bar spine. Palpation of the lumbar musculature may with FHS may truly experience bouts of breakthrough QuickNotes elicit signs of pain. Mydriasis is common during bouts of FHS. Affected cats commonly stare at their tail, then attack the tail and/or flanks. Biting of the tail base, forelegs, and FHS can occur in cats paws is common. These cats neuropathic pain leading to allodynia (sensation of of any age, but it is commonly seen in cats aged 1 to 5 years. often run wildly around the home, vocalizing at the same time. Normally calm cats may display aggression toward people or other cats in the household, pain resulting from non-noxious stimuli, such as a while aggressive cats may display increased affection. The behavior may be induced by pet- ting or stroking the cat’s fur and most commonly light touch), regardless of whether higher brain func- occurs in the morning ©2009 Kelpfish/Shutterstock.com or later in the evening.2 Diagnosis The differential diagnosis for FHS *Adapted with permission from John can be categorized by the type of tions are involved (e.g., displacement behavior). Ciribassi, DVM, and the Veterinary Information Network (VIN). clinical signs displayed: 116 CompendiumVet.com | March 2009 If this is the case, it could partly explain to neuropathic pain. As indicated in my why some cats appear to improve with article, some believe that myopathic certain centrally acting therapies, such as disorders can result in the clinical signs the anticonvulsant gabapentin. This drug seen with FHS. An underlying neuropa- binds to a subunit of the voltage-gated thy may certainly account for these signs. calcium channels in the dorsal horn and is Gabapentin, while often used in treating commonly used for conditions associated seizure disorders, is also well known for with neuropathic pain or with chronic its use in human and veterinary medi- pain when central sensitization is sus- cine for treating neuropathic pain.1,2 As pected, even though clinical studies are a result, it can be difficult to distinguish, lacking in veterinary medicine.1 As such, in patients responding to treatment with a clinical response to gabapentin should gabapentin for FHS, whether the response not necessarily lead the practitioner to is managing a seizure disorder centrally or conclude that the patient was experienc- is exerting peripheral neuropathic effects. ing seizures, as is suggested in this article The advantage of initially using pheno- (p.118), but may instead be the result of a barbital in managing cases in which sei- true neuropathic pain syndrome respond- zures are suspected as the etiology is that ing to an adjuvant analgesic drug. The phenobarbital would not be expected to same reasoning could apply to other act peripherally. As a result, improvement drugs, such as tricyclic antidepressants with phenobarbital would provide a pre- and selective serotonin reuptake inhibitors, sumptive diagnosis of seizure. If pheno- often considered as first-line therapies in barbital proves to be ineffective, turning people with neuropathic pain.2 to gabapentin can help distinguish seizure Louis-Philippe de Lorimier, DVM, from neuropathy. This being said, diagno- DACVIM (Oncology) sis by drug trial does not truly provide a Hôpital Vétérinaire Rive-Sud secure diagnosis. Instead, it merely gives Brossard, Québec circumstantial evidence of an etiology Canada based on the assumption of a known and specific mode of action of the drug that is References providing relief of the signs. 1. Backonja M, Glanzman RL. Gabapentin dosing for neuropathic pain: evidence from randomized, placebo- Dr. John Ciribassi controlled clinical trials. Clin Ther 2003;25:81-104. Chicagoland Veterinary Behavior 2. Verdu B, Decosterd I, Buclin T, et al. Antidepressants for the treatment of chronic pain. Drugs 2008;68:2611- Consultants 2632. Carol Stream, Illinois References 1. Kumar B, Kalita J, Kumar G, Misra UK. Central post- The Author’s Reply stroke pain: a review of pathophysiology and treatment. Thank you for your comments regard- Anesth Analg 2009;108(5):1645-1657. 2. Clivatti J, Sakata RK, Issy AM. Review of the use of ing my article on FHS. It is plausible that gabapentin in the control of postoperative pain. Rev Bras at least some cases of FHS are related Anestesiol 2009;59(1):92-8, 87-92. 254 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com
  9. 9. What do dogs who takee VETORYL (trilostane) ® have in common? Prior to VETO RYL Results like these. treatment Effective treatment for Cushing’s syndrome is now FDA approved. You now have easy access to the most powerful treatment weapon in the fight against canine Cushing’s Following 3 months of with VETORYL syndrome. VETORYL Capsules are the only licensed treatment available for both pituitary-dependent and adrenal-dependent hyperadrenocorticism. VETORYL Capsules contain the active ingredient trilostane, which blocks the excessive production of cortisol. Daily administration of VETORYL can greatly reduce the clinical signs associated with Cushing’s syndrome, enhancing the quality of life for both dog and owner. For more information, visit www.VETORYL.com. Contact your local veterinary distributor to order VETORYL Capsules today! Following 9 months of treatment with VETO RYL Photographs courtesy of Carlos Melian, DVM, PhD (trilostane) VETORYL is a trademark of Dechra Ltd. ©2009, Dechra Ltd. NADA 141-291, Approved by FDA As with all drugs, side effects may occur. In field studies, the most common side effects reported were poor/reduced appetite, vomiting, lethargy, diarrhea, and weakness. Occasionally, more serious side effects, including severe depression, hemorrhagic diarrhea, collapse, hypoadrenocortical crisis, or adrenal necrosis/rupture may occur, and may result in death. VETORYL Capsules are not for use in dogs with primary hepatic or renal disease, or in pregnant dogs. Refer to the prescribing information for complete details or visit www.VETORYL.com. VTYL0209-01-47122-CPD See Page 256 for Product Information Summary
  10. 10. WEB EXCLUSIVES June 2009 Vol 31(6) VETORYL Capsules (trilostane) ® 30 mg and 60 mg strengths Adrenocortical suppressant for oral use in dogs only on BRIEF SUMMARY (For Full Prescribing Information, see package insert.) CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. CE ARTICLES normal testicle DESCRIPTION: VETORYL is an orally active synthetic steroid analogue that blocks production ❯❯ Renal Secondary is located on of hormones produced in the adrenal cortex of dogs. Hyperparathyroidism the right or the INDICATIONS: VETORYL Capsules are ❯❯ Jenefer R. Stillion and Michelle G. Ritt left side (in this indicated or the treatment of pituitary-dependent case the normal hyperadrenocorticism in dogs. VETORYL The parathyroid glands secrete parathyroid Capsules are indicated for the treatment testicle is the of hyperadrenocorticism due to adrenocortical hormone (PTH), which is important for main- tumor in dogs. right testicle). taining calcium homeostasis. Parathyroid The cryptorchid CONTRAINDICATIONS: The use of VETORYL gland hyperplasia and subsequent hyper- ❯❯ Cryptorchidectomy Video 1 Capsules is contraindicated in dogs that have testicle should demonstrated hypersensitivity to trilostane. parathyroidism can occur secondary to Do not use VETORYL Capsules in animals with be located on the contralateral side. primary hepatic disease or renal insufficiency. chronic renal failure in dogs, resulting in Do not use in pregnant dogs. Studies conducted with trilostane in laboratory animals have shown significant alterations in calcium metabolism. VIDEO 2 teratogenic effects and early pregnancy loss. Renal secondary hyperparathyroidism is demonstrates WARNINGS: In case of overdosage, a complex, multifactorial syndrome that use of the symptomatic treatment of hypoadrenocorticism with corticosteroids, mineralocorticoids and intravenous involves changes in circulating levels of vessel-sealing fluids may be required. Angiotensin-converting calcium, PTH, phosphorus, and 1,25-dihy- device to seal enzyme (ACE) inhibitors should be used with caution with VETORYL Capsules, as both drugs have droxycholecalciferol (calcitriol). and section the aldosterone-lowering effects which may be additive, impairing the patient’s ability to maintain normal gubernaculum, electrolytes, blood volume and renal perfusion. spermatic cord, Potassium-sparing diuretics (e.g., spironolactone) WEB-EXCLUSIVE VIDEOS ❯❯ Cryptorchidectomy Video 2 should not be used with VETORYL Capsules as and, finally, the both drugs have the potential to inhibit aldosterone, vascular pedicle increasing the likelihood of hyperkalemia. ❯❯ Laparoscopic and Laparoscopic- of an abdominally cryptorchid testicle. HUMAN WARNINGS: Keep out of reach of children. Assisted Cryptorchidectomy Videos Not for human use. Wash hands after use. Do not empty capsule contents and do not attempt to divide The June 2009 Surgical Views column, If a totally the capsules. Do not handle the capsules if pregnant or if trying to conceive. Trilostane is associated “Laparoscopic and Laporoscopic-Assisted laparoscopic with teratogenic effects and early pregnancy loss Cryptorchidectomy in Dogs and Cats,” cryptorchidec- in laboratory animals. In the event of accidental ingestion/overdose, seek medical advice immediately by Dr. Philipp Mayhew, discusses the tomy is per- and take the labeled container with you. advantages and disadvantages of these formed (VIDEO PRECAUTIONS: Hypoadrenocorticism can techniques. Three videos, contributed 3), the testicle develop at any dose of VETORYL Capsules. A small percentage of dogs may develop by Dr. Mayhew, demonstrate some of the can be removed corticosteroid withdrawal syndrome within 10 days of starting treatment. Mitotane (o,p’-DDD) treatment techniques discussed in this column. through the ❯❯ Cryptorchidectomy Video 3 will reduce adrenal function. Experience in foreign subumbilical markets suggests that when mitotane therapy is stopped, an interval of at least one month should VIDEO 1 demonstrates the manipulation of the port. This way, enlargement of the port can be elapse before the introduction of VETORYL Capsules. The use of VETORYL Capsules will not normal testicle in a unilaterally cryptorchid performed through the linea alba rather than affect the adrenal tumor itself. Adrenalectomy dog. By pushing the normal testicle in a cra- the muscular body wall where the instrument should be considered as an option for cases that are good surgical candidates. nial direction, it is possible to see whether the ports are located. ADVERSE REACTIONS: The most common adverse reactions reported are poor/reduced appetite, vomiting, lethargy/dullness, diarrhea, E-NEWSLETTER and weakness. Occasionally, more serious reactions including severe depression, hemorrhagic diarrhea, collapse, hypoadrenocortical crisis, or adrenal necrosis/rupture may occur, and may result in death. ❯❯ COMPENDIUM EXTRA, a monthly e-newsletter, provides Web-exclusive articles and news as well as a preview of this month’s journal. Sign up at (trilostane) Distributed by: CompendiumVet.com. Dechra Veterinary Products 7015 College Boulevard, Suite 525 Overland Park, KS 66211 www.VETORYL.com 866-933-2472 CONTACT US VETORYL is a trademark of Dechra Ltd. © 2009, Dechra Ltd. NADA 141-291, Approved by FDA ❯❯ E-mail your questions, suggestions, corrections, or letters to the editor: editor@CompendiumVet.com 256 Compendium
  11. 11. Editorial AMERICAN ASSOCIATION OF FELINE Contributed by: PRACTITIONERS About AAFP The American Association of 2008 Feline F eLV and FIV are among the most common infectious diseases of cats. Risk factors for infection include male gender, adulthood, and outdoor access, whereas indoor In a study of more than 18,000 cats tested in 2004, 2.3% were positive for FeLV and 2.5% were positive for FIV.1 Infection rates for FeLV FeLV Vaccination The decision to vaccinate an individual cat against FeLV should be based on the cat’s risk Feline Practitioners improves the health and well-being of cats by supporting high stan- dards of practice, continuing Retrovirus lifestyle and sterilization are associated with reduced infec- tion rates.1–5 The retroviral status of all cats should be known. Cats and FIV (TABLE 1) varied among subpopula- tions and sources of cats. of exposure. Cats that live in a FeLV-negative, indoor environment are at minimal risk. FeLV vaccination is recommended for: education, and scientific inves- tigation. Feline Practitioners are veterinary professionals Management who belong to this association may require retrovirus testing at different times in their lives. Preventing FeLV and FIV Infection because they are “passionate Here are some general principles for retrovirus testing: Vaccines are available for both retroviruses. All kittens because the lifestyles of kittens fre- about the care of cats”! Both FeLV and FIV vaccines are non-core. Risk quently change after acquisition and they may American Association of Feline Guidelines* A cat with a confi rmed-positive test result should be diagnosed as having a retroviral infection—not clinical dis- ease. Diseases in cats infected with FeLV or FIV may not assessment of the individual animal should dictate their use. No vaccine is 100% effec- tive, and repeat testing should be performed subsequently be at risk for FeLV exposure Cats that go outdoors Cats that have direct contact with cats of Practitioners 203 Towne Centre Drive Hillsborough, NJ 08844-4693 phone: 800-874-0498 necessarily be the result of the retrovirus infection. as warranted. unknown status or in high-turnover situations phone: 908-359-9351 Members of the Cats infected with FeLV or FIV may live for many years. fax: 908-292-1188 e-mail: info@catvets.com Advisory Panel A decision for euthanasia should never be made solely on the basis of whether the cat is infected. TABLE 1 Media contact: Valerie Creighton, DVM, ABVP ❯❯ Julie Levy, DVM, PhD, DACVIM, Chair No test is 100% accurate at all times under all conditions. Risk Factors for FeLV and FIV Seropositivity in 18,038 Cats Tested ❯❯ Cynda Crawford, DVM, PhD All test results should be interpreted along with the patient’s at Veterinary Clinics and Animal Shelters in North America1 University of Florida health and prior likelihood of infection. All positive results Number of Cats Number of Cats ❯❯ Katrin Hartmann, Dr. Med. Vet., Dr. Habil., DECVIN-CA should be confirmed by another test method. Number of Cats Factor Categories with Positive Results with Positive Results Ludwig Maximilian University Munich | Munich, Germany Tested While FeLV and FIV can be life-threatening viruses, proper for FeLV(%) for FIV (%) ❯❯ Susan Little, DVM, DABVP (feline practice) management can give infected cats longer, healthier lives. Study site Animal shelter 8068 124 (1.5) 141 (17) Winn Feline Foundation | Manasquan, New Jersey The following article reflects the recommendations of the Veterinary clinic 9970 285 (2.9) 305 (3.1) ❯❯ Eliza Sundahl, DVM, DABVP (Feline Practice) AAFP on managing these infections. KC Cat Clinic | Kansas City, Missouri Region West 3737 39 (1.0) 72 (1.9) Epidemiology ❯❯ Vicki Thayer, DVM, DABVP (Feline Practice) Canada 325 8 (2.5) 10 (3.1) Purrfect Practice | Lebanon, Oregon The prevalence of FeLV infection has reportedly decreased during the past 20 years, presumably as a result of implemen- South 6359 144 (2.3) 183 (2.9) ❯❯ Regina Hoffmann-Lehmann, Dr. Med. Vet.,Dr. Habil, FVH tation of widespread testing programs and development of Northeast 3747 107 (2.9) 79 (2.1) University of Zurich | Zurich, Switzerland effective vaccines.1,2,6 In contrast, the prevalence of FIV has not changed since the virus was discovered in 1986. Midwest 3870 111 (2.9) 102 (2.6) At a Glance Source Clinic (indoors only) 3613 53 (1.5) 32 (0.9) Epidemiology Clinic (outdoors access) 6357 232 (3.6) 273 (4.3) Disclaimer Page XXX About These Guidelines These guidelines Shelter (relinquished pet) 2809 41 (1.5) 38 (1.4) This report is an abridged version of the Retrovirus Guidelines are not exclusive. Preventing FeLV and FIV Infection Page XXX of the American Association of Feline Practitioners (AAFP) to Shelter (stray) 4550 71 (1.6) 75 (1.6) Other techniques and guide veterinary practitioners who want to optimize the care Shelter (feral) 709 12 (1.7) 28 (3.9) procedures may be Limiting Transmission in the Veterinary Practice and management of feline patients. It represents a consensus available. The AAFP Page XXX of current information compiled by the researchers and Age Juvenile 9556 131 (1.4) 100 (1.0) expressly disclaim Diagnosing FeLV and FIV practitioners on the panel. Adult 8482 278 (3.3) 346 (4.1) any warranties or Page XXX The guidelines in this report are based on the best research guarantees, express Managing Positive Cats data, clinical experience and technical judgments available at Sex Spayed female 2611 45 (1.7) 82 (1.2) or implied, and shall ❯❯ Margie Scherk, DVM, Page XXX the time of preparation. While the guidelines are as accurate Neutered male 2984 88 (2.9) 127 (4.3) not be liable for any and comprehensive as possible, they are subject to change damages of any kind should new insights become available from additional Sexually intact female 6588 128 (1.9) 44 (1.7) in connection with *This is an abridged version of the full guidelines (Levy JC, research or technological updates. Sexually intact male 5855 148 (2.5) 193 (3.3) the material, informa- Crawford C, Hartmann K, et al. 2008 American Associa- The AAFP is a professional organization of practitioners and tion, techniques, or tion of Feline Practitioners’ feline retrovirus management DABVP (Feline Medicine) guidelines. J Feline Med Surg 2008;10[3]:300-316), available board-certified specialists who seek to raise the standards of Health status Healthy 15,312 238 (1.6) 280 (1.8) procedures set forth at Catvets.com from the American Association of Feline feline medicine and surgery among practitioners. Sick 2726 171 (6.3) 166 (6.1) in these guidelines. Practitioners (AAFP). Adapted with permission of AAFP. 472 Compendium | June 2009 | CompendiumVet.com CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 473 Vancouver, British Columbia The new Feline Focus series begins on page 264. Feline Focus B y now, you know that Compendium is launch- the cornerstone to management and prevention ing several new series this year, and excite- of the spread of FeLV and FIV and that all cats ment is building! So what’s new in the should be tested, especially when they are ill? journal for you and your feline patients? The Vaccination should be considered only in adult American Association of Feline Practitioners (AAFP) cats that are deemed to live in an at-risk environ- is partnering with Compendium to shine the ment (i.e., FeLV and FIV vaccines are not core spotlight on cats on a quarterly basis in Feline for adult cats). However, FeLV vaccination is now Focus! This series will provide you with pertinent recommended as core for cats younger than 1 and timely updates in feline medicine, covering year. Do you know what the risk for FeLV or FIV a myriad of useful and useable facts to help you is in your region? help cats in your practice. It will include brief In addition to providing recommendations on abstracts and conference pearls; how-to articles preventing retrovirus infections, the guidelines are about approaching specific problems in cats, as an excellent source of information about caring for well as handling and working more peacefully retrovirus-positive cats—not only pet cats but also and effectively with the more difficult members of those in cattery, shelter, and rescue situations. Do this species; and summaries of AAFP guidelines. clients ask you whether fencing is adequate for iso- lation of retrovirus-positive cats from uninfected While FIV and FeLV vaccines are not cats, or what kinds of disinfectant they need to use? Do you know how often a cat with FeLV should considered core for adult cats, FeLV is a be examined and which tests should be conducted core vaccine for cats younger than 1 year. at each visit, or what drugs have been shown to be effective in the treatment of FeLV or FIV? If Every column will be peer-reviewed by a dip- the answers to any of these questions intrigue you, lomate specialist and approved by a representa- the practical, scientifically solid article in this issue tive of the AAFP. Together, Compendium and the should be a useful clinic resource. AAFP want to provide more access to informa- Welcome to Feline Focus! We look forward to tion about feline medicine, brought to you by growing a relationship with you based on solid, sources you know you can trust. practical feline facts. In this premiere offering of Feline Focus, we are pleased to share with you the 2008 AAFP Cheers! Feline Retrovirus Management Guidelines. Not Margie excited yet? Let me whet your appetite. For exam- ple, did you know that testing, not vaccination, is CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 257

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