Case Studies

Hypertonic Nasal Saline Drops for an Upper Respiratory Infection

Feb 5, 2014

A 10 year-old FS DSH presented for chronic sneezing and nasal discharge. The owner reported that she had been placed on antibiotics several times in the past with some improvement but no resolution of clinical signs. On physical examination, she had bilateral mucopurulent nasal discharge, moderate dental disease and referred upper respiratory noise on auscultation of her lungs. Diagnostics offered to the owner included blood work, nasal radiographs, rhinoscopy +/- biopsy and culture if indicated. A dental was also recommended. The owner elected to start with blood work, and a dental with nasal radiographs. The blood work revealed a leukocytosis. The remainder of the blood work was within normal limits, including a negative FIV/FeLV.  The nasal radiographs were performed under general anesthesia at the same time as the dental. The radiographs revealed a mild increased density of both nasal passages. Oral Zithromax® (Azithromycin), Chlorpheniramine and Cerenia® (Maropitant citrate) tablets were dispensed for a total of 3 weeks. The doses were as follows:  Chlorpheniramine 2 mg PO BID; Cerenia for 5 days initially then twice weekly; Zithromax 20 mg PO once daily. Cerenia works to reduce nasal discharge and itchiness from infection, and also works well with antihistamines as they potentiate each other. Hypertonic saline and neopolydex ophthalmic drops were also dispensed to be applied to the nasal passages twice daily for 3 weeks. DermaFlush Premixed Saline Packets were used to make the hypertonic saline nasal drops by simply adding 2 of the premixed saline packets to 1 Liter of water. The hypertonic saline was then placed in a dropper bottle and instructions were to instill several drops to both nasal passages twice daily prior to application of the neopolydex ophthalmic drops. Hypertonic saline works to help reduce edema and flush out debris. DermaFlush Saline Packets are an economic and convenient form of saline when added to water. The saline is soothing, preservative and iodine free, and may be made into an isotonic or hypertonic saline. The patient returned for a re-check after 3 weeks and her sneezing and nasal discharge had resolved. She was sent home on an L-lysine supplement and was told to call or return for a re-check if the discharge and/or sneezing...

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GlycoZoo Case Study

Jan 3, 2014

A 5 year-old female spayed cocker spaniel presented for a routine annual veterinary examination. On physical examination, she had grade 2/4 dental disease, a  greasy, malodorous coat with generalized scaling and was slightly overweight. The owner reported that that patient was not pruritic but did notice that she smelled badly. Skin cytology and skin scraping were performed and found to be negative. Blood work (including a thyroid level) and a urinalysis were submitted to the laboratory, and returned normal besides a slightly elevated Alkaline Phosphatase (ALKP), which was attributed to the dental disease. A DTM was also performed and negative results were obtained a few weeks later. The patient was diagnosed with a mild form of seborrhea oleosa (greasy seborrhea) and was sent home with GlycoZoo Shampoo and Spray Conditioner to be used 2-3 times a week for 3 weeks, until re-check. The owner was instructed to lather, massage, and then allow skin contact time of at least 10 minutes before rinsing the GlycoZoo Shampoo. The GlycoZoo Spray Conditioner is leave-in, dry-on and may be used after bathing (as was done in this case) or alone. Seborrhea is an inherited disorder of keratinization. Seborrhea (excessive scaling) is associated with abnormal (accelerated) epidermal turnover which gives rise to excessive scaling. Seborrhea oleosa (greasy seborrhea) is typified by greasy skin and haircoat, a malodor, and brown-yellow scales and sebum that clump to the hair and skin. Keratolytic agents, such as Glycolic Acid, may be used to treat seborrhea complex. Keratolytic agents loosen adhesion between cells in the epithelium and facilitate cell shedding (removal of excess scale). The patient returned for a dental 3 weeks later and the coat was significantly improved with decreased scaling, and no odor or greasiness appreciated. The Glycolic Acid worked to exfoliate the excess dead skin cells as a result of the seborrhea, and the drying effects of the Boric Acid helped to degrease the skin and coat. Both ingredients helped to remove the odor. A routine dental under general anesthesia was performed with no extractions and the patient was sent home with T/Edta/C Dental Wipes to maintain a good oral hygiene regimen at home. The owner was also instructed to use the GlycoZoo Shampoo and Spray Conditioner weekly for maintenance to keep the skin and coat healthy. Please submit any case studies you may have using DermaZoo or OtoPet-USA products to jessvet3@aol.com.   What is Glycolic Acid? Glycolic Acid is the current gold standard in chemical exfoliants available within the human dermatology market. It is a gentle yet effective acid from the Alpha-Hydroxy Acid (AHA) family and derived from sugar cane. It is the smallest molecule of the Alpha-Hydroxy Acid (AHA) family and this is one of reason it’s such a great chemical exfoliant. It dissolves the glue between the dead cells in the upper most layer of the epidermis, which then causes those excess dulling, clogging and unhealthy dead cells to fall off; which is the definition of exfoliation: the removal of dead cells. This information was obtained from www.dermtv.com, Dr. Neal Schultz, M.D. GlycoZoo Dermatology Products utilize 2% glycolic and boric acids with ceramides, and are available in shampoo, spray, wipes and otic. GlycoZoo has now introduced the “gold standard of chemical exfoliants” to the veterinary market. GlycoZoo products may be used for maintenance, deodorizing and also to aid in the topical treatment of seborrhea complex and other conditions where Glycolic Acid and/or Boric Acid may be...

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The Earigator: Wound Flushing

Sep 9, 2013

The Earigator: Wound Flushing

The Earigator may be used in other ways besides flushing ears. If presented with a bite wound that needs to be flushed under pressure, the Earigator may be used along with DermaFlush(™) Premixed Saline Packets. DermaFlush is a saline crystal packet that when added to water creates a saline solution which can be used anywhere a saline flush may be beneficial, including ears, sinuses, wounds and external surgery. DermaFlush will be available in October 2013. Prior to using the  Earigator to flush a wound, clean and flush the unit and the tubing with a mild bleach solution and water. Then cut the tip off the catheter tipped end of a 10 – 12 Fr red rubber feeding tube to fit the trumpet valve nipple. Fill the Earigator flush bottle with a saline solution made with DermaFlush(™). The catheter can be used, with the fluid under pressure, to snake under the skin and into loose skin or muscle tissue and wash abscesses and fistulated areas. The saline acts as an osmotic agent helping to reduce edema and the pressure provided by the Earigator can help remove debris, such as purulent discharge that may be present in an infected wound. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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Case Study: Tooth Fracture

Aug 15, 2013

Case Study: Tooth Fracture

A 5 year-old female mix breed dog presented for left facial swelling. On oral examination, the upper left 4th premolar was found to have a fractured crown with an exposed pulp cavity and gingival swelling surrounding the tooth. The patient was placed on Clindamycin for 2 days duration pending blood work, which was normal despite a neutrophilia. A fractured tooth with obviously exposed pulp, a discolored tooth, facial swelling, and a draining tract are all indications of endodontic disease. A root canal or extraction must be performed on a fractured or worn tooth with pulp exposure. The owners declined referral to a dentist and elected for extraction of the tooth. The patient was placed under general anesthesia for a dental cleaning and extraction of the upper left 4th premolar. The veterinarian used the OtoPet-USA Video Otoscope full image lens to take a picture of the broken tooth after the  pulp was removed and prior to extraction. This picture was printed for the veterinarian’s records and for the client. The patient was sent home on Clindamycin for a total of 2 weeks, as well as Rimadyl and Tramadol to control pain and inflammation. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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Image of a Ruptured Tympanic Membrane

Jul 15, 2013

Image of a Ruptured Tympanic Membrane

It is important to visualize and clean the ear canals in order to effectively manage cases of chronic otitis. The OtoPet-USA Video Vetscope may be used for visualization in conjunction with the OtoPet-USA Earigator, which may be used to lavage, suction and remove debris from the ear canals. Excessive debris must be cleaned out for several reasons when managing cases of otitis. Debris can block the penetration of topical agents to the affected tissue requiring treatment, and large deposits may prevent medication from reaching the deeper parts of the ear canal. Larger clumps of debris that remain in the ear canal may sequester organisms as well. Debris can also protect microbes that are attached to keratinocytes, and therefore, covered with a protective lipid layer. These organisms may survive therapy and then infect the ear again.  Retained debris may also contain pro-inflammatory substances, such as microbial byproducts and toxins. Additionally, purulent discharge may interfere with the effectiveness of some antibiotics. Finally, it is often necessary to clean the ear of debris simply to be able to properly to visualize the tympanum. Below is a case study demonstrating the use of the Video VetScope and Earigator to visualize and clean an ear with chronic otitis. A middle-aged dog presented with a unilateral chronic otitis for several months duration. He had a normal examination besides pain, erythema and purulent discharge from the affected ear. He was placed under general anesthesia, which was required to completely assess the ear canal and for a through otic flushing. An endotracheal tube was placed and the patient was positioned in lateral recumbency. Initially, it was difficult to assess the tympanic membrane as there was discharge obstructing the view. With visualization using the Video VetScope, samples of the discharge were taken for cytology and culture and sensitivity prior to flushing the ear canal. Rods were visualized on cytology. Using the Earigator, the ear canal was then copiously flushed with a warmed saline to remove the discharge. Alligator forceps inserted through the Video VetScope probe may be used to remove any excess debris if needed as well. Finally, the ear was evaluated again with the Video VetScope to assess the tympanic membrane, which was found to be ruptured. An image of the ruptured tympanic membrane was captured and can be seen here. The patient was sent home on oral Zenequin® pending the culture and sensitivity results, a tapering dose of steroids and a topical mixture of tris-EDTA, Dexamethasone SP and Baytril®. The culture and sensitivity revealed Pseudomonas, which was sensitive to Zenequin®. The patient was continued on oral Zenequin®, tris-EDTA, Dexamethasone SP and Baytril® applied topically twice daily for 4 weeks, as well as instructed to finish the tapering dose of steroids that was initially prescribed. The plan was to repeat cytology and re-evaluate 3 weeks later but the patient didn’t return for follow-up. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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Case Study: Tick Infestation in Ear Canal Diagnosis and Treatment

Jun 17, 2013

Case Study: Tick Infestation in Ear Canal Diagnosis and Treatment

A 5 year-old female mixed breed dog from Arizona was presented for head shaking and discomfort for several days duration. A physical examination was performed and within normal limits. Next, an otoscopic examination was performed in the exam room using the OtoPet-USA Video Vetscope. The Video Vestcope probe was inserted into both ear canals. The image here of the left ear canal was visualized and captured using the video monitor. The owner was able to see the ticks within the left ear canal on the monitor, and the dog was taken into the procedure room for removal of the ticks. This was a case of Otobius megnini infestation. Otobius megnini, the spinous ear tick, is a soft-bodied tick found in the Southwest United States. The parasitic larvae and nymphs feed within the ear causing a significant inflammatory reaction in the ear canal. Treatment includes removal of the tick, appropriate tick control measures and management of the associated otitis. The two soft-bodied tick nymphs identified as Otobius megnini were removed from the ear canal using alligator forceps placed through the OtoPet-USA Video Vetscope probe while visualizing the procedure on the monitor. The patient was then placed on Frontline for tick control, and a topical otic steroid to treat the secondary inflammation associated with the infestation. An image of another patient in Texas with an Otobius megnini tick within the ear is on the left. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia at...

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Proper Ear Cleaning

May 16, 2013

Proper Ear Cleaning

In order to effectively manage cases of otitis it is very important to thoroughly clean the ear canals. It is often the most important step in managing otitis, as cases may become chronic without proper cleaning. In order to effectively clean ears the OtoPet-USA Earigator should be used for lavage and suction of the ear canal to remove debris along with the OtoPet-USA Video VetScope, which allows for visualization of the ear canal. It is extremely important to clean out excessive or abnormal debris when managing cases of otitis. Debris can block the penetration of topical agents to the affected tissue requiring treatment, and large deposits may prevent medication from reaching the deeper parts of the ear canal. Larger clumps of debris that remain in the ear canal may sequester organisms as well. Debris can also protect microbes that are attached to keratinocytes, and therefore, covered with a protective lipid layer. These organisms may survive therapy and then infect the ear again.  Retained debris may also contain pro-inflammatory substances, such as microbial byproducts and toxins. Additionally, purulent discharge may interfere with the effectiveness of some antibiotics. Finally, it is often necessary to clean the ear of debris simply to be able to properly to visualize the tympanum. Below is a case study demonstrating the use of the Earigatorand Video VetScope to clean an ear with excessive debris. In this case, the patient was placed under general anesthesia, which is required for a through otic flushing. An endotracheal tube was placed and the patient was positioned in lateral recumbency. The ear canal was visualized using the Video VetScope. If needed, samples for cytology, culture and sensitivity should be collected and imaging studies should be performed prior to flushing the ear canal. The type of discharge in the ear directs the selection of an appropriate initial flush. If the discharge is waxy, a cleaner with good ceruminolytic properties should be used. If the discharge is mucoid and purulent, an aqueous cleaner is preferable. Copious flushing of the ear canal with a warmed aqueous flush should be performed after the initial flush to remove any residual ear cleanser and minimize any irritation or adverse reaction from the cleanser. Flushing also helps to remove debris. A ceruminolytic cleanser was initially instilled into this ear to break up the thick cerumen. This was followed by a warm aqueous flush using the Earigator. See directions below on how to use the Earigator. Finally, the ear was evaluated again with the Video VetScope to ensure it was clean. Alligator forceps inserted through the Video VetScope probe may be used to remove any excess debris if needed as well. In this case most of the debris was removed with the Earigator and a few residual pieces required removal with forceps. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia at jessvet3@aol.com. To read and view previous Case Studies, visit the Case Studies...

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Air Bubbles: Diagnosing a Ruptured Tympanic Membrane

Apr 10, 2013

Air Bubbles: Diagnosing a Ruptured Tympanic Membrane

A 14 year-old female spayed DSH presented for head shaking, scratching at both ears and owner-reported decreased hearing for several weeks duration. Her medical history included chronic ear infections over several years, all treated with Tresaderm. The other cat in the house was healthy with no history of otitis. On physical examination, the patient had brown ceruminous discharge, hyperemia of the ear canal, and pain in the left ear. She had mild ceruminous discharge in the right ear. She also had dental disease. Ear cytology revealed 3+ cocci and 3+ yeast with no mites in the left ear and negative in the right ear. The client was asked to return the patient for a dental, ear flush and ear culture under general anesthesia the following day as long as the blood work and urinalysis were within normal limits. Blood work (Chemistry/CBC/T4) and a urinalysis were all within normal limits. The patient was placed under general anesthesia and a routine dental with no extractions was performed. The OtoPet-USA Video Vetscope was used to evaluate both ears. The right ear had a small amount of cerumen and an intact tympanic membrane was visualized. The right ear was then cleaned with warm saline using the OtoPet-USA Earigator. The left ear had a large amount of discharge obstructing the view of the tympanic membrane. When there is a large amount of exudate present in the ear canal a thorough deep ear cleaning may be needed to evaluate the tympanum. Warmed saline can be used to clean the ear and can be helpful in assessing if the tympanic membrane is ruptured. The anesthetized patient is placed in lateral recumbency with the affected ear up. The ear canal is filled with warmed saline and the VetScope probe is inserted into the ear canal. If air bubbles are seen in the saline that rise when the patient breathes, then the tympanic membrane is ruptured. Air from the nasopharynx rises through the auditory tube, into the tympanic bulla, and it escapes into the external ear canal through the ruptured tympanic membrane. Water was gently placed into the left ear using the Earigator to determine if the membrane was intact, and air bubbles were visualized. View the video of air bubbles visualized and captured using the VetScope here. The ear was then gently cleaned with sterile saline using the Earigator after a sample from the middle ear was taken for bacterial culture and sensitivity. Flushing the external ear and middle ear canals is an important step in treating otitis. Debris in the ear canal and middle ear can inactivate some topical medications and prevent medications from contacting the infected tissues, as well as perpetuate infection and stimulate inflammation. She was sent home on the following oral medications: Fluconazole, a tapering dose of Prednisolone, and Clavamox pending the culture, as there were yeast and cocci on cytology. The bacterial culture revealed Staphylococcus, which is sensitive to Clavamox. Topical medications were not initially used. However, some clinicians may choose to instill antibiotic or steroid directly into the middle ear after cleaning the ear with visualization using the  VetScope, or dispense topical medications to be used at home. At the 3 week re-check, both ears had intact tympanic membranes with the right ear clear and mild erythema and discharge in the left ear. Cytology was negative in the right...

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Chronic Otitis Case Study

Mar 1, 2013

Chronic Otitis Case Study

Dr. Benaryeh from Spicewood Animal Hospital was presented with a dog that had been suffering with chronic ear infections for 6 years. Fortunately, Dr. Benaryeh acquired the OtoPet-USA Video Vetscope Tower System, and while the dog was under general anesthesia he was able to visualize polyps covering the tympanic membranes of both ears. Pictures of the polyps were taken and printed for the owner. The equipment also allowed Dr. Benaryeh to remove the polyps with forceps through the 2mm working channel attached to the videoscope. Once the polyps were removed they were sent to the lab for evaluation. Additionally, a swab of the exudate was taken with the videoscope probe through the working channel, and then a cytology slide was made for evaluation. The exudate was found to be rods on cytology and the appropriate topical medication, such as Triz-EDTA with Baytril and DexSP, was dispensed. During the procedure the videoscope working channel was also used to obtain a culture from both ears. The cultures allowed Dr. Benaryeh to prescribe the appropriate oral antibiotic, as oral antibiotics are dispensed based on culture and sensitivity, while topical antibiotics reach concentrations well above the minimal inhibitory concentration on the culture and sensitivity, and as a result can be used topically even if the bacteria is resistant. The Earigator was used during the procedure, and Dr. Benaryeh was amazed by the visualization and quality while irrigating and flushing the ears. Fortunately, the polyps that were causing the chronic ear infections were found to be benign. The dog is now comfortable and doing well. The underlying cause for the chronic otitis was addressed and the patient hasn’t presented with otitis again. Ear problems can be chronic and difficult to treat. As a general practitioner, you likely see several patients with ear infections daily, and there is nothing more frustrating then unsuccessfully trying to treat these ear infections. When these patients present we usually do cytology and treat accordingly. However, many of these patients eventually present again with the same infection in the same ear. However, the OtoPet-USA Video Vetscope allows you to visualize and successfully treat these ear problems everyday. The equipment allows you to look inside the ear and get great visualization. You can see what you couldn’t see before. You can visualize tympanic membranes, intact or ruptured, find polyps in the horizontal ear canal or sometimes even foreign bodies. These are just a few of the chronic offenders that make treating otitis so challenging. There is a lens offered with the videoscope equipment as well. The lens attaches to your hospital microscope and allows you to take a picture of the cytology. The picture can be printed for owners or sent to other veterinarians for evaluation. The tower system also comes with an Earigator that is used to irrigate and flush the ears. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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Asperigillosis Case Study

Mar 1, 2013

Murray Animal Hospital, Murray, Kentucky Presentation: A middle-age, male Great Dane presented to Murray Animal Hospital with sanguineous nasal discharge for several weeks duration. Diagnostics: The dog was sedated and the vetscope probe was placed into both the right and left nasal passages. The vetscope probe enabled them to visualize several polyps in both of the nasal passages. The polyps were visualized on the monitor, and pictures were printed for the record and for the owners. Then a videoscope-guided biopsy was obtained using forceps that were attached to the vetscope probe. The biopsy was sent to the laboratory. The biopsy results came back as nasal Aspergillosis, a treatable fungal infection. Treatment: The Aspergillosis was treated with the oral antifungal, Itraconazole, for 1 month beyond last detection of the infection as evidenced by lack of nasal discharge and a re-check exam with sedation and normal nasal passages as visualized with the vestcope probe. The dog is now doing very well. If you have an interesting case that you would like to submit with pictures, please contact Dr. Jessica Melman Bhatia...

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