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A 14-year-old 12.5-kg (27.5-lb) female mixed-breed dog with a recent diagnosis of hyperadrenocorticism and diabetes mellitus was evaluated as part of a recheck examination and because of lack of appetite, which had worsened in the last few weeks, and episodes of panting that lasted several hours. Further recent medical history included hind limb trembling and hospitalization for hypoglycemia-induced seizures. The dog vomited once while in the examination room. During recheck examination, muscle wasting and a decrease in proprioception in the hind limbs were observed, and the abdomen was tense on palpation. Findings of serum biochemical analysis were consistent with

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To evaluate the effects of twice-daily oral administration of a low-dose of trilostane treatment and assess the duration of effects after once-daily trilostane administration in dogs with naturally occurring hyperadrenocorticism (NOH).

Design—Prospective study.

Animals—28 dogs with NOH.

Procedures—22 dogs received 0.5 to 2.5 mg of trilostane/kg (0.23 to 1.14 mg/lb) orally every 12 hours initially. At intervals, dogs were reevaluated; owner assessment of treatment response was recorded. To assess drug effect duration, 16 of the 22 dogs and 6 additional dogs underwent 2 ACTH stimulation tests 3 to 4 hours and 8 to 9 hours after once-daily trilostane administration.

Results—After 1 to 2 weeks, mean trilostane dosage was 1.4 mg/kg (0.64 mg/lb) every 12 hours (n = 22 dogs; good response [resolution of signs], 8; poor response, 14). Four to 8 weeks later, mean dosage was 1.8 mg/kg (0.82 mg/lb) every 12 or 8 hours (n = 21 and 1 dogs, respectively; good response, 15; poor response, 5; 2 dogs were ill). Eight to 16 weeks after the second reevaluation, remaining dogs had good responses (mean dosages, 1.9 mg/kg [0.86 mg/lb], q 12 h [n = 13 dogs] and 1.3 mg/kg [0.59 mg/lb], q 8 h [3]). At 3 to 4 hours and 8 to 9 hours after once-daily dosing, mean post-ACTH stimulation serum cortisol concentrations were 2.60 and 8.09 μg/dL, respectively.

Conclusions and Clinical Relevance—In dogs with NOH, administration of trilostane at low doses every 12 hours was effective, although 2 dogs became ill during treatment. Drug effects diminished within 8 to 9 hours. Because of potential adverse effects, lower doses should be evaluated.

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in Journal of the American Veterinary Medical Association

Abstract

Case Description—A 12-year-old Miniature Dachshund with a history of permanent endocardial pacemaker implantation performed 7 weeks previously was admitted for routine dental prophylaxis.

Clinical Findings—Preanesthetic ECG revealed normal ventricular capture. Thoracic radiographic findings included caudomedial displacement of the endocardial pacemaker lead. Echocardiography revealed moderate chronic degenerative valve disease with moderate left atrial and ventricular dilation. After induction of anesthesia, loss of ventricular capture was detected. The dog recovered from anesthesia and had improved ventricular capture. The following day, surgical exposure of the cardiac apex revealed perforation of the right ventricular apex by the passive-fixation pacemaker lead.

Treatment and Outcome—A permanent epicardial pacemaker was implanted through a transxiphoid approach. Appropriate ventricular capture and sensing were achieved. The dog recovered without complications. Approximately 2 months later, the dog developed sudden respiratory distress at home and was euthanized.

Clinical Relevance—In dogs with permanent pacemakers and loss of ventricular capture, differential diagnoses should include cardiac perforation. If evidence of perforation of the pacemaker lead is found, replacement of the endocardial pacemaker lead with an epicardial pacemaker lead is warranted.

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in Journal of the American Veterinary Medical Association

Consider the following scenarios:

A novice veterinarian asking for guidance in performing a technical procedure for the first time.

An experienced veterinarian calling a former classmate to discuss a challenging case that is not responding to treatment as expected.

A close veterinary colleague helping you navigate through a state board complaint against you.

A group of peer veterinarians meeting monthly to manage stresses associated with balancing family and career responsibilities.

The commonality in these examples is that they all provide opportunities for clinical supervision.

Clinical supervision is typically thought of as regular and frequent meetings between a supervisee and trained

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in Journal of the American Veterinary Medical Association

Abstract

Case Description—A 3-year-old sexually intact male Standard Poodle was admitted to the veterinary teaching hospital for transcatheter closure of a large atrial septal defect (ASD).

Clinical Findings—The dog had exercise intolerance and was thin. Findings on physical examination were within normal limits with the exception of a left base systolic heart murmur (grade 5/6). The dog was not receiving any medications. Echocardiography and thoracic radiography confirmed the diagnosis of ASD and revealed compensatory changes consistent with a large left to right shunting ASD. Results of serum biochemical analysis and CBC were within reference range limits.

Treatment and Outcome—Transcatheter ASD closure with an atrial septal occluder (ASO) was performed and failed. An open heart surgical approach under cardiopulmonary bypass was declined by the dog's owners. The dog underwent a novel hybrid approach involving active device fixation under temporary inflow occlusion after transatrial device deployment. The dog recovered with some manageable postoperative complications. As of the last follow-up examination, the dog had 10 months of event-free survival.

Clinical Relevance—Transcatheter closure by use of an ASO and open heart patch repair with cardiopulmonary bypass to surgically treat dogs with ASD has been reported. Transcatheter closure is not possible in dogs with large ASD. The novel hybrid procedure reported herein represented a viable alternative to euthanasia.

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in Journal of the American Veterinary Medical Association