CANINE LARYNGEAL PARALYSIS: THE INSPIRATION AND THE

In Our Community
Please join us in support of the following organizations and be
sure to stop by the VSH booth and say “Hi.”
Saturday, May 9
San Diego Humane Society Walk for Animals
Liberty Station
San Diego
San Diego: 858 875 7500
San Marcos: 760 466 0600
Sunday, June 7
RB Alive” Street Fair
Bernardo Center Drive
Rancho Bernardo
TAKE NOTE
cURRENT CLINICAL TRIALs
Internal Medicine –Gastrointestinal Foreign Body (FB)
and Pancreatitis Study
VSH (Sorrento Valley and San Marcos) is now enrolling dogs with
gastrointestinal FBs for evaluation of SNAP and Spec cPL values at
various phases during diagnosis and removal of the FB. Dogs must
have a confirmed FB removed via endoscopy or surgery. All cases
will have funded SNAP and Spec cPLs at several time points.
Clients will also receive a no charge recheck appointment and cPLs.
Contact Drs. Lauren Cochran or Steve Hill at (858) 875-7500
Internal Medicine – Feline Hepatic Lipidosis Study
Now enrolling cats with confirmed hepatic lipidosis (HL) with the
objective of evaluating vitamin-B metabolism and lipid profiles
associated with this disease process. This is a 4-week prospective
study which requires whole blood and urine collected at the time of
diagnosis and at 2 and 4 week rechecks. The objective of this study
is to expand our understanding of vitamin-B and lipid metabolism
in cats with HL. Patients that have received cobalamin or folic acid
supplementation within 8 weeks prior to diagnosis of HL may not
be included in this study (supplementation is permitted following
receipt of the first samples at the time of diagnosis).
Contact Drs. Alexandra Hamilton or Steve Hill at (858) 875-7500
Internal Medicine – Canine IBD and Probiotic VSL#3
We are enrolling dogs with chronic gastrointestinal signs that are
suspected of having idiopathic inflammatory bowel disease (IBD).
Endoscopy will be performed, and if IBD is confirmed, dogs will be
randomized to receive treatment with prednisone and diet, or
prednisone, diet and probiotic VSL#3. This is an 8-week study
requiring two endoscopic procedures. The cost of the initial
workup is partially funded and the cost of the probiotic and the
second endoscopy will be fully funded.
Contact Dr. Steve Hill at (858) 875-7500 x702
CONNECTED
10435 Sorrento Valley Rd
Suite 100
San Diego, CA 92121
Y o u r L i n k t o V e t e r i n a r y S P E C IA L T Y H O S P ITA L | A P R – J UN 2 0 15
Sunday, April 26
At the FACE Foundation’s 5th Annual Bags &
Baubles fundraiser, a fashion-loving crowd will
have the chance to bid on new and “gently
loved” handbags, jewelry and accessories at a
beautiful, private Rancho Santa Fe estate! Guests
can enjoy a wonderful opportunity drawing,
estate tours and delicious wine, appetizers and
desserts…all to benefit pets in need of critical
veterinary care! Event tickets start at just $10.
www.bagsandbaubles.org
Internal Medicine – Glomerular Disease Study
VSH is participating in a multi-center prospective study
evaluating increased dosing of enalapril in dogs with glomerular
disease. Client incentives include reduced cost of some initial
testing and no cost for scheduled recheck visits and tests.
Contact Dr. Julie Fischer at (760) 466-0600
Oncology – Conditionally Licensed Monoclonal Antibody + CCNU
Chemotherapy for Dogs with T-Cell Lymphoma
The Veterinary Specialty Hospital of San Diego is currently
enrolling cases in a nationwide clinical trial to evaluate a monclonal antibody that is conditionally licensed by the USDA to aid
in the treatment of dogs with lymphoma. The study is designed to
assess the benefit of adding the antibody to a single-agent CCNU
chemotherapy protocol for dogs with intermediate to high grade
T-cell lymphoma. The trial will pay to screen dogs with lymphoma
to determine whether they have T-cell lymphoma in order to be
eligible for the trial.
Contact Dr. Brenda Phillips at (858) 875-7500
Oncology – Funded Trial for Dogs with Cancer
Clients enrolling and completing a study evaluating the use of a
probiotic along with chemotherapy will receive funding toward
doxorubicin chemotherapy. Large dogs with any form of cancer
responsive to doxorubicin chemotherapy are eligible, including
those already on doxorubicin. Some breed or patient exclusions
may apply.
Contact Dr. Andi Flory at (760) 466-0600 or (858) 875-7500
Oncology – Canine Lymphoma Trial
We are now accepting enrollment for dogs with multicentric
lymphoma in several trials.
Contact Dr. Brenda Phillips at (858) 875-7500
Oncology – Quality of Life for Cats with GI Lymphoma
This is a trial that will lead to the design of a validated quality
of life survey tool for cats with GI lymphoma. This will enable the
profession to study different interventions that may impact quality
of life. Clients will be required to fill out survey information to
develop this tool. If you have an UNTREATED cat with GI lymphoma (or suspect GI lymphoma), they are eligible to participate.
Contact Drs. Brenda Phillips or Keith Richter at (858) 875-7500
For more details about these and other clinical trials, please visit our website at www.vshsd.com.
Announcements
save the date
Dr. Blaise Burke will be delivering a research abstract in May at the
annual meeting of the European Society of Veterinary Oncology in
Krakow, Poland. The abstract, titled “Prognostic Factors in Canine
Patients Treated with Definitive and Palliative Radiotherapy”, is
based on information from patients treated here at VSH. Dr. Burke
will also be lecturing over two days to the faculty and students at
the Nantes-Atlantique Veterinary College in Nantes, France. He will
be covering the principles and practice of radiation therapy with
special attention to side effects and long-term outcomes.
May 17, 2015 – VSH 5th Annual Symposium
8:00 am - 4:30 pm at the University of San Diego
Keynote: Dr. Danny Scott of Cornell University, renowned
expert in Dermatology.
Multiple Educational Tracks for Veterinarians, Technicians, Managers and
Client Care Specialists
Dr. Brenda Phillips, one of our medical oncologists, is pleased to join
the Community Advisory Board at the Sanford-Burnham Institute.
She will join other individuals on the board who are passionate
about educating the public about cancer and the world class cancer
research being conducted at Sanford-Burnham. Please join Dr.
Phillips and the other CAB members at the Institute open house for
the public in La Jolla on June 11. This is a spectacular, firsthand
opportunity for you to see cancer studies in action.
Specialists Drs. Keith Richter, Steve Hill and Kate Arnell, along with
residents, Drs. Lauren Cochran and Alexandra Hamilton attended the
2015 Comparative Gastroenterology Society’s (CGS) GutSea meeting
in Belize, Central America in March. Drs. Hamilton and Cochran each
presented research abstracts. Dr. Cochran’s was titled Evaluation of
canine pancreas-specific lipase concentrations in dogs with
gastrointestinal foreign bodies, while Dr. Hamilton presented: Serum
markers of vitamin B metabolism in cats with hepatic lipidosis.
Hurry - There’s Still Time to Register! Visit www.vshsd.com for details.
WE’RE LISTENING
Thanks to everyone who participated in our annual survey. One
consistent theme is to ensure that each and every client experience
in our hospital is at the highest level possible. Your client’s experience should match the quality of medicine we provide and we are
already taking steps to make sure this happens. You will soon receive
a communication that summarizes all the key findings and our
next steps.
Dr. Steve Hill will be speaking on liver, pancreas and GI topics at the
AIVPA International Congress/SIVOY International Symposium in
Bologna, Italy April 11th-13th.
Canine Laryngeal
Paralysis: The
Inspiration AND
the Aspiration
IN THIS ISSUE:
Cytology Versus Biopsy:
Comparisons of Accuracy — PART 2
Dr. Keith Richter was the Hepatobiliary Section Editor, and Drs. Hill,
Phillips, and Pike wrote chapters in the newest edition of Veterinary
Clinical Advisor. Dr. Richter is also writing 2 chapters for the
upcoming edition of Ettinger’s Textbook of Internal Medicine.
For more information on Continuing Education events,
please visit vshsd.com/Veterinarians or contact Ann Ong
at (858) 875-7544 or [email protected].
Clinical Trials
Upcoming Events
SAN DIEGO 10435 Sorrento Valley Rd San Diego, CA 92121 | NORTH COUNTY 2055 Montiel Rd San Marcos, CA 92069 | www.vshsd.com
Richter scale
Hello Friends and Colleagues,
I hope you are all having a wonderful Spring! Many of you probably got our fax/
email about the new organization VSH is creating with 3 other specialty hospitals
(IVG in Boston, Wheat Ridge in Denver, and Premier in Chicago). I am personally
very excited to be able to pull this off, which will give VSH many of the advantages of a larger organization (purchasing power, group “best practices”, a robust
educational platform for our staff, ability to do multicenter clinical trials, and
more). The best part is that we preserve our local autonomy and decision making,
something very important to me as the founder of VSH. More to come as things
progress.
Our 5th (yes 5th!) annual Symposium in the middle of May features Danny Scott
as the keynote speaker. I’m proud to say that Dr. Scott was one of my former
professors at Cornell, and literally wrote the book on dermatology. It promises
to be a very exciting day!
One of the exciting landmarks coming up this summer is the VSH 25th anniversary!
It was August 1990 when we opened the door with 3 employees. We gradually
added doctors, starting with Drs. Hart and Hill, then Drs. Jackson, DeBerry,
Levitski-Osgood, Lipsitz, and Pike. Then the floodgates really opened, and the rest
is history. In our two San Diego locations, we are up to 28 specialists and 180+
employees. Seems crazy! As an aside, our Hong Kong location has been very well
received. After only 3 months, we are much busier than even our optimism
predicted, and we are already recruiting for more specialists.
On the sports front, all I think about is baseball. Yes, the Padres are the real deal.
It’s great to be down a run or two and not feel like we have no chance. There is a
palpable buzz I haven’t seen for a long time. Anything short of the World Series
will be a disappointment! The lightning bolt I shaved into my dog’s side has finally
grown out, so now I can shave him with the Padres logo. Won’t he be proud!
Keith Richter, DVM
Diplomate ACVIM
Canine Laryngeal
Paralysis: The Inspiration
and the Aspiration
Cytology Versus Biopsy:
Comparisons of Accuracy
by KATY FRYER, dvm, dacvS
Director and Clinical Cytologist, STAT Veterinary Laboratory
Laryngeal paralysis is one of the more common upper respiratory
emergencies seen in our aging canine population. It is frequently
diagnosed in the spring to summer time as the weather begins to
warm and we are more active with our canine companions.
Clinical signs of this disease can be relatively harmless such as
change in bark, occasional regurgitation, or intolerance of activity,
and are often written off by our clients as normal aging changes.
Conversely, dogs can also be presented with life threatening
respiratory distress, hyperthermia, and collapse.
Laryngeal paralysis results from a failure of the cricoarytenoideus
dorsalis muscle to contract appropriately during the inspiratory
phase of the respiration, causing the arytenoid cartilages and the
vocal folds to remain in a paramedian position obstructing
laryngeal airflow. When discussing this process to clients, I often
liken the arytenoid cartilages to curtains which are supposed to
be drawn open and out of the airway during inhalation to allow
airflow into the lungs. With laryngeal paralysis it is as if someone
has cut the drawstring to our curtains and they can no longer be
opened, instead remaining in the center of the airway impeding
air movement.
Hereditary forms of laryngeal paralysis have been reported in
Bouviers des Flandres, Dalmations, Rottweilers, Siberian Huskies,
white coated German Shepherd dogs, Bull Terriers, Leonberger
dogs and Pyrenean Mountain dogs. In these dogs, clinical signs
generally manifest at a fairly young age. The prognosis for
hereditary laryngeal paralysis is considered to be poor with most
dogs dying or being euthanized by two years of age.
Idiopathic disease is diagnosed in up to 89% of cases of laryngeal
paralysis. The median age at presentation is 11 years, with male
dogs being 1.5 times more frequently affected than females. Large
and giant breed dogs are over represented, with Labradors,
Chesapeakes, Great Danes, Irish Setters, and Afghan Hounds being
the most often affected.
Complete work up of patients prior to interventions should be
performed. This should include thoracic auscultation to evaluate
for evidence of pneumonia or pulmonary edema, a complete
neurologic exam to evaluate for polyneuropathies which may be
associated with myasthenia gravis or hypothyroidism, and thoracic
radiographs to evaluate for megaesophagus and the presence of a
compressive mediastinal mass. CBC and chemistry profile are also
recommended, although they often are unremarkable.
Definitive diagnosis of laryngeal paralysis is most often achieved
by performing oral laryngoscopy. A light plane of anesthesia is
required for evaluation, with single agent anesthetic protocols of
either thiopental or propofol yielding the fewest false positives.
Doxapram may be used at a dose of 1mg/kg to augment ventilatory efforts. It is important to differentiate paradoxical motion
from true motion during laryngeal evaluation. Alternative means
of diagnosis include echo laryngography and transnasal laryngoscopy which may be performed with minimal to no sedation.
Conservative treatment of laryngeal paralysis can include weight
loss, avoiding situations of stress, excitement, and increased ambient temperatures, sedatives, and occasionally steroids to decrease
inflammation. Surgery is considered the most effective means of
treating and palliating the signs associated with laryngeal
paralysis. Surgery is contraindicated if concurrent megaesophagus
is observed.
The primary goals of surgical treatment are to enlarge the airway,
decrease resistance to inspiratory airflow and to maintain
resistance during expiration. Though many different surgical
techniques have been performed, arytenoid lateralization is
considered the gold standard of treatment. In small animals,
lateralization methods have evolved by borrowing from equine
surgical techniques. Generally a left lateral approach to the
arytenoid cartilage is performed and one or two sutures of 2-0
polypropylene on a tapered needle are used to secure the muscular
process of the arytenoid cartilage to the caudodorsal cricoid
cartilage. Intraoperative laryngeal examination is recommended
to ensure appropriate abduction as it may reduce the incidence of
post-operative complications.
With surgery, reported mortality ranges from 0% to as high as
67% if a bilateral lateralization is performed. Aspiration pneumonia is the most frequently reported complication occurring in
somewhere between 8-21% of dogs. Aspiration pneumonia
remains a lifelong risk for dogs undergoing lateralization although
it appears that dogs may undergo an adjustment period following
surgery ultimately making them less likely to develop pneumonia
as the time from surgery increases. Minor complications reported
to be associated with surgery include coughing, gagging, seroma
formation, vomiting, and continued exercise intolerance.
Though it is known to be associated with a polyneuropathy and is
most frequently seen in our geriatric dog population, laryngeal
paralysis can be successfully managed or treated surgically.
Overall, up to 90% of surgical outcomes have been reported
satisfactory by owner perception, with most animals achieving
resolution of respiratory signs.
[Part 2]
by Andrew S. Loar, DVM, DACVIM (Oncology and Internal Medicine),
In our previous newsletter, interpretive issues associated with the
evaluation of accuracy of cytology were examined. In the literature,
investigators have examined the diagnostic accuracy of cytologic
analyses, compared to the presumptive gold standard of histopathology, for the evaluation of tissues in a number of selected anatomical
locations. Various studies have addressed lesions identified from the
skeleton, gastrointestinal and respiratory tracts, subcutaneous and
dermal sites, liver, spleen, lymph nodes and prostate gland. For each
site, the diagnostic sensitivity, specificity and accuracy of cytology
will be described, as well as other significant factors relevant to the
correlation of microscopic diagnosis and disease within each of
these systems.
Bony Lesions
Compared to diagnoses derived from histologic analysis, using
incisional (core) and/or excisional (generally via amputation) biopsy,
cytology findings from radiographically identified bone lesions are
variably accurate, particularly dependent on whether the process is
neoplastic versus inflammatory. In several studies of more than 50
canine bony lesions, the vast majority of which were in long bones,
cytologic evaluations were in agreement with biopsy results in
approximately 70% of the cases. It is noteworthy that incisional
biopsy results were in agreement with excisional biopsy findings in
only 54% of the cases; examination of excisional bone specimens is
considered the reference/gold standard. However, there was marked
variation in the accuracy of cytology for identification of neoplastic
compared with non-neoplastic conditions; more than 90% of the
cytologic diagnoses of bony tumors were confirmed via biopsy, while
less than 30% of cases with cytologic findings of non-neoplastic
(generally inflammatory) disease were verified on histopathology –
the majority of these discordant cases were confirmed via biopsy
to be neoplastic.
In summary, using needle aspirates of lytic/proliferative skeletal
lesion, less than 10% of all cytologic diagnoses of neoplasia are
shown to be non-neoplastic (low false positive rate), while more
than 70% of all cases without cytologic evidence of neoplasia are
ultimately confirmed to be tumor (high false negative rate). The
factor that most significantly influences diagnostic accuracy is the
overall cellularity of the cytologic specimen; samples with low to
poor cellularity, which arguably could be interpreted as nondiagnostic, were most frequently associated with a poor correlation
to subsequent biopsy analysis. In practical terms, the clinician can
generally expect that a cytologic diagnosis of bony neoplasia from a
highly cellular aspirate is accurate and reliable; in contrast, the
majority of cytologic diagnoses of non-neoplastic (inflammatory)
bony disease, particularly from samples of low cellularity, should be
re-aspirated or biopsied to verify tumor.
Gastrointestinal Tumors
Compared to diagnoses using histology, generally from full thickness
or endoscopically derived biopsies, cytology findings from gastrointestinal tumors show impressive accuracy. In several studies of more
than 100 canine and feline gastrointestinal tumors, cytologic
evaluations of samples with acceptable cellularity were in agreement
with biopsy results in nearly 90% of the cases. The highest levels of
agreement, with specificities and sensitivities of virtually 100%,
were from cytology specimens representing impression smears of
the biopsy samples, many of which were submitted as intraoperative slides.
Tumor types in these studies included gastrointestinal lymphoma,
carcinoma and mesenchymal neoplasia (leiomyoma and leiomyosarcoma). As stated above, specificity of cytology evaluation from fine
needle aspirates of all tumors was nearly 100%. However the rate of
false negative cytology results (sensitivity) varied by cell type; the
highest sensitivity was found in the cytologic diagnosis of lymphoma
(71%), followed by gastrointestinal carcinoma (63%) and mesenchymal tumors (44%). There has been no accuracy study published for
non-neoplastic gastrointestinal lesions. It is noteworthy that
investigations of gastrointestinal biopsy results have showed
significant variation in diagnoses when more than one anatomic
pathologist reviews the specimens; one study found interobserver
disagreement associated with more than 50% of intestinal lesions
examined. Moreover, regarding the proposed gold standard for
verification of gastrointestinal disease, many dispute the comparative
accuracy of biopsy results derived from full thickness surgical
excision versus those obtained endoscopically. It is therefore critical
that endoscopic biopsies are read by pathologists skilled in endoscopic histopathology.
Subsequent newsletter issues will address comparative studies
examining tissue diagnoses using needle aspirates versus biopsy
specimens for lesions within the respiratory tract, cutaneous and
hepatic sites.
Referenced studies are available from the Author.
Richter scale
Hello Friends and Colleagues,
I hope you are all having a wonderful Spring! Many of you probably got our fax/
email about the new organization VSH is creating with 3 other specialty hospitals
(IVG in Boston, Wheat Ridge in Denver, and Premier in Chicago). I am personally
very excited to be able to pull this off, which will give VSH many of the advantages of a larger organization (purchasing power, group “best practices”, a robust
educational platform for our staff, ability to do multicenter clinical trials, and
more). The best part is that we preserve our local autonomy and decision making,
something very important to me as the founder of VSH. More to come as things
progress.
Our 5th (yes 5th!) annual Symposium in the middle of May features Danny Scott
as the keynote speaker. I’m proud to say that Dr. Scott was one of my former
professors at Cornell, and literally wrote the book on dermatology. It promises
to be a very exciting day!
One of the exciting landmarks coming up this summer is the VSH 25th anniversary!
It was August 1990 when we opened the door with 3 employees. We gradually
added doctors, starting with Drs. Hart and Hill, then Drs. Jackson, DeBerry,
Levitski-Osgood, Lipsitz, and Pike. Then the floodgates really opened, and the rest
is history. In our two San Diego locations, we are up to 28 specialists and 180+
employees. Seems crazy! As an aside, our Hong Kong location has been very well
received. After only 3 months, we are much busier than even our optimism
predicted, and we are already recruiting for more specialists.
On the sports front, all I think about is baseball. Yes, the Padres are the real deal.
It’s great to be down a run or two and not feel like we have no chance. There is a
palpable buzz I haven’t seen for a long time. Anything short of the World Series
will be a disappointment! The lightning bolt I shaved into my dog’s side has finally
grown out, so now I can shave him with the Padres logo. Won’t he be proud!
Keith Richter, DVM
Diplomate ACVIM
Canine Laryngeal
Paralysis: The Inspiration
and the Aspiration
Cytology Versus Biopsy:
Comparisons of Accuracy
by KATY FRYER, dvm, dacvS
Director and Clinical Cytologist, STAT Veterinary Laboratory
Laryngeal paralysis is one of the more common upper respiratory
emergencies seen in our aging canine population. It is frequently
diagnosed in the spring to summer time as the weather begins to
warm and we are more active with our canine companions.
Clinical signs of this disease can be relatively harmless such as
change in bark, occasional regurgitation, or intolerance of activity,
and are often written off by our clients as normal aging changes.
Conversely, dogs can also be presented with life threatening
respiratory distress, hyperthermia, and collapse.
Laryngeal paralysis results from a failure of the cricoarytenoideus
dorsalis muscle to contract appropriately during the inspiratory
phase of the respiration, causing the arytenoid cartilages and the
vocal folds to remain in a paramedian position obstructing
laryngeal airflow. When discussing this process to clients, I often
liken the arytenoid cartilages to curtains which are supposed to
be drawn open and out of the airway during inhalation to allow
airflow into the lungs. With laryngeal paralysis it is as if someone
has cut the drawstring to our curtains and they can no longer be
opened, instead remaining in the center of the airway impeding
air movement.
Hereditary forms of laryngeal paralysis have been reported in
Bouviers des Flandres, Dalmations, Rottweilers, Siberian Huskies,
white coated German Shepherd dogs, Bull Terriers, Leonberger
dogs and Pyrenean Mountain dogs. In these dogs, clinical signs
generally manifest at a fairly young age. The prognosis for
hereditary laryngeal paralysis is considered to be poor with most
dogs dying or being euthanized by two years of age.
Idiopathic disease is diagnosed in up to 89% of cases of laryngeal
paralysis. The median age at presentation is 11 years, with male
dogs being 1.5 times more frequently affected than females. Large
and giant breed dogs are over represented, with Labradors,
Chesapeakes, Great Danes, Irish Setters, and Afghan Hounds being
the most often affected.
Complete work up of patients prior to interventions should be
performed. This should include thoracic auscultation to evaluate
for evidence of pneumonia or pulmonary edema, a complete
neurologic exam to evaluate for polyneuropathies which may be
associated with myasthenia gravis or hypothyroidism, and thoracic
radiographs to evaluate for megaesophagus and the presence of a
compressive mediastinal mass. CBC and chemistry profile are also
recommended, although they often are unremarkable.
Definitive diagnosis of laryngeal paralysis is most often achieved
by performing oral laryngoscopy. A light plane of anesthesia is
required for evaluation, with single agent anesthetic protocols of
either thiopental or propofol yielding the fewest false positives.
Doxapram may be used at a dose of 1mg/kg to augment ventilatory efforts. It is important to differentiate paradoxical motion
from true motion during laryngeal evaluation. Alternative means
of diagnosis include echo laryngography and transnasal laryngoscopy which may be performed with minimal to no sedation.
Conservative treatment of laryngeal paralysis can include weight
loss, avoiding situations of stress, excitement, and increased ambient temperatures, sedatives, and occasionally steroids to decrease
inflammation. Surgery is considered the most effective means of
treating and palliating the signs associated with laryngeal
paralysis. Surgery is contraindicated if concurrent megaesophagus
is observed.
The primary goals of surgical treatment are to enlarge the airway,
decrease resistance to inspiratory airflow and to maintain
resistance during expiration. Though many different surgical
techniques have been performed, arytenoid lateralization is
considered the gold standard of treatment. In small animals,
lateralization methods have evolved by borrowing from equine
surgical techniques. Generally a left lateral approach to the
arytenoid cartilage is performed and one or two sutures of 2-0
polypropylene on a tapered needle are used to secure the muscular
process of the arytenoid cartilage to the caudodorsal cricoid
cartilage. Intraoperative laryngeal examination is recommended
to ensure appropriate abduction as it may reduce the incidence of
post-operative complications.
With surgery, reported mortality ranges from 0% to as high as
67% if a bilateral lateralization is performed. Aspiration pneumonia is the most frequently reported complication occurring in
somewhere between 8-21% of dogs. Aspiration pneumonia
remains a lifelong risk for dogs undergoing lateralization although
it appears that dogs may undergo an adjustment period following
surgery ultimately making them less likely to develop pneumonia
as the time from surgery increases. Minor complications reported
to be associated with surgery include coughing, gagging, seroma
formation, vomiting, and continued exercise intolerance.
Though it is known to be associated with a polyneuropathy and is
most frequently seen in our geriatric dog population, laryngeal
paralysis can be successfully managed or treated surgically.
Overall, up to 90% of surgical outcomes have been reported
satisfactory by owner perception, with most animals achieving
resolution of respiratory signs.
[Part 2]
by Andrew S. Loar, DVM, DACVIM (Oncology and Internal Medicine),
In our previous newsletter, interpretive issues associated with the
evaluation of accuracy of cytology were examined. In the literature,
investigators have examined the diagnostic accuracy of cytologic
analyses, compared to the presumptive gold standard of histopathology, for the evaluation of tissues in a number of selected anatomical
locations. Various studies have addressed lesions identified from the
skeleton, gastrointestinal and respiratory tracts, subcutaneous and
dermal sites, liver, spleen, lymph nodes and prostate gland. For each
site, the diagnostic sensitivity, specificity and accuracy of cytology
will be described, as well as other significant factors relevant to the
correlation of microscopic diagnosis and disease within each of
these systems.
Bony Lesions
Compared to diagnoses derived from histologic analysis, using
incisional (core) and/or excisional (generally via amputation) biopsy,
cytology findings from radiographically identified bone lesions are
variably accurate, particularly dependent on whether the process is
neoplastic versus inflammatory. In several studies of more than 50
canine bony lesions, the vast majority of which were in long bones,
cytologic evaluations were in agreement with biopsy results in
approximately 70% of the cases. It is noteworthy that incisional
biopsy results were in agreement with excisional biopsy findings in
only 54% of the cases; examination of excisional bone specimens is
considered the reference/gold standard. However, there was marked
variation in the accuracy of cytology for identification of neoplastic
compared with non-neoplastic conditions; more than 90% of the
cytologic diagnoses of bony tumors were confirmed via biopsy, while
less than 30% of cases with cytologic findings of non-neoplastic
(generally inflammatory) disease were verified on histopathology –
the majority of these discordant cases were confirmed via biopsy
to be neoplastic.
In summary, using needle aspirates of lytic/proliferative skeletal
lesion, less than 10% of all cytologic diagnoses of neoplasia are
shown to be non-neoplastic (low false positive rate), while more
than 70% of all cases without cytologic evidence of neoplasia are
ultimately confirmed to be tumor (high false negative rate). The
factor that most significantly influences diagnostic accuracy is the
overall cellularity of the cytologic specimen; samples with low to
poor cellularity, which arguably could be interpreted as nondiagnostic, were most frequently associated with a poor correlation
to subsequent biopsy analysis. In practical terms, the clinician can
generally expect that a cytologic diagnosis of bony neoplasia from a
highly cellular aspirate is accurate and reliable; in contrast, the
majority of cytologic diagnoses of non-neoplastic (inflammatory)
bony disease, particularly from samples of low cellularity, should be
re-aspirated or biopsied to verify tumor.
Gastrointestinal Tumors
Compared to diagnoses using histology, generally from full thickness
or endoscopically derived biopsies, cytology findings from gastrointestinal tumors show impressive accuracy. In several studies of more
than 100 canine and feline gastrointestinal tumors, cytologic
evaluations of samples with acceptable cellularity were in agreement
with biopsy results in nearly 90% of the cases. The highest levels of
agreement, with specificities and sensitivities of virtually 100%,
were from cytology specimens representing impression smears of
the biopsy samples, many of which were submitted as intraoperative slides.
Tumor types in these studies included gastrointestinal lymphoma,
carcinoma and mesenchymal neoplasia (leiomyoma and leiomyosarcoma). As stated above, specificity of cytology evaluation from fine
needle aspirates of all tumors was nearly 100%. However the rate of
false negative cytology results (sensitivity) varied by cell type; the
highest sensitivity was found in the cytologic diagnosis of lymphoma
(71%), followed by gastrointestinal carcinoma (63%) and mesenchymal tumors (44%). There has been no accuracy study published for
non-neoplastic gastrointestinal lesions. It is noteworthy that
investigations of gastrointestinal biopsy results have showed
significant variation in diagnoses when more than one anatomic
pathologist reviews the specimens; one study found interobserver
disagreement associated with more than 50% of intestinal lesions
examined. Moreover, regarding the proposed gold standard for
verification of gastrointestinal disease, many dispute the comparative
accuracy of biopsy results derived from full thickness surgical
excision versus those obtained endoscopically. It is therefore critical
that endoscopic biopsies are read by pathologists skilled in endoscopic histopathology.
Subsequent newsletter issues will address comparative studies
examining tissue diagnoses using needle aspirates versus biopsy
specimens for lesions within the respiratory tract, cutaneous and
hepatic sites.
Referenced studies are available from the Author.
Richter scale
Hello Friends and Colleagues,
I hope you are all having a wonderful Spring! Many of you probably got our fax/
email about the new organization VSH is creating with 3 other specialty hospitals
(IVG in Boston, Wheat Ridge in Denver, and Premier in Chicago). I am personally
very excited to be able to pull this off, which will give VSH many of the advantages of a larger organization (purchasing power, group “best practices”, a robust
educational platform for our staff, ability to do multicenter clinical trials, and
more). The best part is that we preserve our local autonomy and decision making,
something very important to me as the founder of VSH. More to come as things
progress.
Our 5th (yes 5th!) annual Symposium in the middle of May features Danny Scott
as the keynote speaker. I’m proud to say that Dr. Scott was one of my former
professors at Cornell, and literally wrote the book on dermatology. It promises
to be a very exciting day!
One of the exciting landmarks coming up this summer is the VSH 25th anniversary!
It was August 1990 when we opened the door with 3 employees. We gradually
added doctors, starting with Drs. Hart and Hill, then Drs. Jackson, DeBerry,
Levitski-Osgood, Lipsitz, and Pike. Then the floodgates really opened, and the rest
is history. In our two San Diego locations, we are up to 28 specialists and 180+
employees. Seems crazy! As an aside, our Hong Kong location has been very well
received. After only 3 months, we are much busier than even our optimism
predicted, and we are already recruiting for more specialists.
On the sports front, all I think about is baseball. Yes, the Padres are the real deal.
It’s great to be down a run or two and not feel like we have no chance. There is a
palpable buzz I haven’t seen for a long time. Anything short of the World Series
will be a disappointment! The lightning bolt I shaved into my dog’s side has finally
grown out, so now I can shave him with the Padres logo. Won’t he be proud!
Keith Richter, DVM
Diplomate ACVIM
Canine Laryngeal
Paralysis: The Inspiration
and the Aspiration
Cytology Versus Biopsy:
Comparisons of Accuracy
by KATY FRYER, dvm, dacvS
Director and Clinical Cytologist, STAT Veterinary Laboratory
Laryngeal paralysis is one of the more common upper respiratory
emergencies seen in our aging canine population. It is frequently
diagnosed in the spring to summer time as the weather begins to
warm and we are more active with our canine companions.
Clinical signs of this disease can be relatively harmless such as
change in bark, occasional regurgitation, or intolerance of activity,
and are often written off by our clients as normal aging changes.
Conversely, dogs can also be presented with life threatening
respiratory distress, hyperthermia, and collapse.
Laryngeal paralysis results from a failure of the cricoarytenoideus
dorsalis muscle to contract appropriately during the inspiratory
phase of the respiration, causing the arytenoid cartilages and the
vocal folds to remain in a paramedian position obstructing
laryngeal airflow. When discussing this process to clients, I often
liken the arytenoid cartilages to curtains which are supposed to
be drawn open and out of the airway during inhalation to allow
airflow into the lungs. With laryngeal paralysis it is as if someone
has cut the drawstring to our curtains and they can no longer be
opened, instead remaining in the center of the airway impeding
air movement.
Hereditary forms of laryngeal paralysis have been reported in
Bouviers des Flandres, Dalmations, Rottweilers, Siberian Huskies,
white coated German Shepherd dogs, Bull Terriers, Leonberger
dogs and Pyrenean Mountain dogs. In these dogs, clinical signs
generally manifest at a fairly young age. The prognosis for
hereditary laryngeal paralysis is considered to be poor with most
dogs dying or being euthanized by two years of age.
Idiopathic disease is diagnosed in up to 89% of cases of laryngeal
paralysis. The median age at presentation is 11 years, with male
dogs being 1.5 times more frequently affected than females. Large
and giant breed dogs are over represented, with Labradors,
Chesapeakes, Great Danes, Irish Setters, and Afghan Hounds being
the most often affected.
Complete work up of patients prior to interventions should be
performed. This should include thoracic auscultation to evaluate
for evidence of pneumonia or pulmonary edema, a complete
neurologic exam to evaluate for polyneuropathies which may be
associated with myasthenia gravis or hypothyroidism, and thoracic
radiographs to evaluate for megaesophagus and the presence of a
compressive mediastinal mass. CBC and chemistry profile are also
recommended, although they often are unremarkable.
Definitive diagnosis of laryngeal paralysis is most often achieved
by performing oral laryngoscopy. A light plane of anesthesia is
required for evaluation, with single agent anesthetic protocols of
either thiopental or propofol yielding the fewest false positives.
Doxapram may be used at a dose of 1mg/kg to augment ventilatory efforts. It is important to differentiate paradoxical motion
from true motion during laryngeal evaluation. Alternative means
of diagnosis include echo laryngography and transnasal laryngoscopy which may be performed with minimal to no sedation.
Conservative treatment of laryngeal paralysis can include weight
loss, avoiding situations of stress, excitement, and increased ambient temperatures, sedatives, and occasionally steroids to decrease
inflammation. Surgery is considered the most effective means of
treating and palliating the signs associated with laryngeal
paralysis. Surgery is contraindicated if concurrent megaesophagus
is observed.
The primary goals of surgical treatment are to enlarge the airway,
decrease resistance to inspiratory airflow and to maintain
resistance during expiration. Though many different surgical
techniques have been performed, arytenoid lateralization is
considered the gold standard of treatment. In small animals,
lateralization methods have evolved by borrowing from equine
surgical techniques. Generally a left lateral approach to the
arytenoid cartilage is performed and one or two sutures of 2-0
polypropylene on a tapered needle are used to secure the muscular
process of the arytenoid cartilage to the caudodorsal cricoid
cartilage. Intraoperative laryngeal examination is recommended
to ensure appropriate abduction as it may reduce the incidence of
post-operative complications.
With surgery, reported mortality ranges from 0% to as high as
67% if a bilateral lateralization is performed. Aspiration pneumonia is the most frequently reported complication occurring in
somewhere between 8-21% of dogs. Aspiration pneumonia
remains a lifelong risk for dogs undergoing lateralization although
it appears that dogs may undergo an adjustment period following
surgery ultimately making them less likely to develop pneumonia
as the time from surgery increases. Minor complications reported
to be associated with surgery include coughing, gagging, seroma
formation, vomiting, and continued exercise intolerance.
Though it is known to be associated with a polyneuropathy and is
most frequently seen in our geriatric dog population, laryngeal
paralysis can be successfully managed or treated surgically.
Overall, up to 90% of surgical outcomes have been reported
satisfactory by owner perception, with most animals achieving
resolution of respiratory signs.
[Part 2]
by Andrew S. Loar, DVM, DACVIM (Oncology and Internal Medicine),
In our previous newsletter, interpretive issues associated with the
evaluation of accuracy of cytology were examined. In the literature,
investigators have examined the diagnostic accuracy of cytologic
analyses, compared to the presumptive gold standard of histopathology, for the evaluation of tissues in a number of selected anatomical
locations. Various studies have addressed lesions identified from the
skeleton, gastrointestinal and respiratory tracts, subcutaneous and
dermal sites, liver, spleen, lymph nodes and prostate gland. For each
site, the diagnostic sensitivity, specificity and accuracy of cytology
will be described, as well as other significant factors relevant to the
correlation of microscopic diagnosis and disease within each of
these systems.
Bony Lesions
Compared to diagnoses derived from histologic analysis, using
incisional (core) and/or excisional (generally via amputation) biopsy,
cytology findings from radiographically identified bone lesions are
variably accurate, particularly dependent on whether the process is
neoplastic versus inflammatory. In several studies of more than 50
canine bony lesions, the vast majority of which were in long bones,
cytologic evaluations were in agreement with biopsy results in
approximately 70% of the cases. It is noteworthy that incisional
biopsy results were in agreement with excisional biopsy findings in
only 54% of the cases; examination of excisional bone specimens is
considered the reference/gold standard. However, there was marked
variation in the accuracy of cytology for identification of neoplastic
compared with non-neoplastic conditions; more than 90% of the
cytologic diagnoses of bony tumors were confirmed via biopsy, while
less than 30% of cases with cytologic findings of non-neoplastic
(generally inflammatory) disease were verified on histopathology –
the majority of these discordant cases were confirmed via biopsy
to be neoplastic.
In summary, using needle aspirates of lytic/proliferative skeletal
lesion, less than 10% of all cytologic diagnoses of neoplasia are
shown to be non-neoplastic (low false positive rate), while more
than 70% of all cases without cytologic evidence of neoplasia are
ultimately confirmed to be tumor (high false negative rate). The
factor that most significantly influences diagnostic accuracy is the
overall cellularity of the cytologic specimen; samples with low to
poor cellularity, which arguably could be interpreted as nondiagnostic, were most frequently associated with a poor correlation
to subsequent biopsy analysis. In practical terms, the clinician can
generally expect that a cytologic diagnosis of bony neoplasia from a
highly cellular aspirate is accurate and reliable; in contrast, the
majority of cytologic diagnoses of non-neoplastic (inflammatory)
bony disease, particularly from samples of low cellularity, should be
re-aspirated or biopsied to verify tumor.
Gastrointestinal Tumors
Compared to diagnoses using histology, generally from full thickness
or endoscopically derived biopsies, cytology findings from gastrointestinal tumors show impressive accuracy. In several studies of more
than 100 canine and feline gastrointestinal tumors, cytologic
evaluations of samples with acceptable cellularity were in agreement
with biopsy results in nearly 90% of the cases. The highest levels of
agreement, with specificities and sensitivities of virtually 100%,
were from cytology specimens representing impression smears of
the biopsy samples, many of which were submitted as intraoperative slides.
Tumor types in these studies included gastrointestinal lymphoma,
carcinoma and mesenchymal neoplasia (leiomyoma and leiomyosarcoma). As stated above, specificity of cytology evaluation from fine
needle aspirates of all tumors was nearly 100%. However the rate of
false negative cytology results (sensitivity) varied by cell type; the
highest sensitivity was found in the cytologic diagnosis of lymphoma
(71%), followed by gastrointestinal carcinoma (63%) and mesenchymal tumors (44%). There has been no accuracy study published for
non-neoplastic gastrointestinal lesions. It is noteworthy that
investigations of gastrointestinal biopsy results have showed
significant variation in diagnoses when more than one anatomic
pathologist reviews the specimens; one study found interobserver
disagreement associated with more than 50% of intestinal lesions
examined. Moreover, regarding the proposed gold standard for
verification of gastrointestinal disease, many dispute the comparative
accuracy of biopsy results derived from full thickness surgical
excision versus those obtained endoscopically. It is therefore critical
that endoscopic biopsies are read by pathologists skilled in endoscopic histopathology.
Subsequent newsletter issues will address comparative studies
examining tissue diagnoses using needle aspirates versus biopsy
specimens for lesions within the respiratory tract, cutaneous and
hepatic sites.
Referenced studies are available from the Author.
In Our Community
Please join us in support of the following organizations and be
sure to stop by the VSH booth and say “Hi.”
Saturday, May 9
San Diego Humane Society Walk for Animals
Liberty Station
San Diego
San Diego: 858 875 7500
San Marcos: 760 466 0600
Sunday, June 7
RB Alive” Street Fair
Bernardo Center Drive
Rancho Bernardo
TAKE NOTE
cURRENT CLINICAL TRIALs
Internal Medicine –Gastrointestinal Foreign Body (FB)
and Pancreatitis Study
VSH (Sorrento Valley and San Marcos) is now enrolling dogs with
gastrointestinal FBs for evaluation of SNAP and Spec cPL values at
various phases during diagnosis and removal of the FB. Dogs must
have a confirmed FB removed via endoscopy or surgery. All cases
will have funded SNAP and Spec cPLs at several time points.
Clients will also receive a no charge recheck appointment and cPLs.
Contact Drs. Lauren Cochran or Steve Hill at (858) 875-7500
Internal Medicine – Feline Hepatic Lipidosis Study
Now enrolling cats with confirmed hepatic lipidosis (HL) with the
objective of evaluating vitamin-B metabolism and lipid profiles
associated with this disease process. This is a 4-week prospective
study which requires whole blood and urine collected at the time of
diagnosis and at 2 and 4 week rechecks. The objective of this study
is to expand our understanding of vitamin-B and lipid metabolism
in cats with HL. Patients that have received cobalamin or folic acid
supplementation within 8 weeks prior to diagnosis of HL may not
be included in this study (supplementation is permitted following
receipt of the first samples at the time of diagnosis).
Contact Drs. Alexandra Hamilton or Steve Hill at (858) 875-7500
Internal Medicine – Canine IBD and Probiotic VSL#3
We are enrolling dogs with chronic gastrointestinal signs that are
suspected of having idiopathic inflammatory bowel disease (IBD).
Endoscopy will be performed, and if IBD is confirmed, dogs will be
randomized to receive treatment with prednisone and diet, or
prednisone, diet and probiotic VSL#3. This is an 8-week study
requiring two endoscopic procedures. The cost of the initial
workup is partially funded and the cost of the probiotic and the
second endoscopy will be fully funded.
Contact Dr. Steve Hill at (858) 875-7500 x702
CONNECTED
10435 Sorrento Valley Rd
Suite 100
San Diego, CA 92121
Y o u r L i n k t o V e t e r i n a r y S P E C IA L T Y H O S P ITA L | A P R – J UN 2 0 15
Sunday, April 26
At the FACE Foundation’s 5th Annual Bags &
Baubles fundraiser, a fashion-loving crowd will
have the chance to bid on new and “gently
loved” handbags, jewelry and accessories at a
beautiful, private Rancho Santa Fe estate! Guests
can enjoy a wonderful opportunity drawing,
estate tours and delicious wine, appetizers and
desserts…all to benefit pets in need of critical
veterinary care! Event tickets start at just $10.
www.bagsandbaubles.org
Internal Medicine – Glomerular Disease Study
VSH is participating in a multi-center prospective study
evaluating increased dosing of enalapril in dogs with glomerular
disease. Client incentives include reduced cost of some initial
testing and no cost for scheduled recheck visits and tests.
Contact Dr. Julie Fischer at (760) 466-0600
Oncology – Conditionally Licensed Monoclonal Antibody + CCNU
Chemotherapy for Dogs with T-Cell Lymphoma
The Veterinary Specialty Hospital of San Diego is currently
enrolling cases in a nationwide clinical trial to evaluate a monclonal antibody that is conditionally licensed by the USDA to aid
in the treatment of dogs with lymphoma. The study is designed to
assess the benefit of adding the antibody to a single-agent CCNU
chemotherapy protocol for dogs with intermediate to high grade
T-cell lymphoma. The trial will pay to screen dogs with lymphoma
to determine whether they have T-cell lymphoma in order to be
eligible for the trial.
Contact Dr. Brenda Phillips at (858) 875-7500
Oncology – Funded Trial for Dogs with Cancer
Clients enrolling and completing a study evaluating the use of a
probiotic along with chemotherapy will receive funding toward
doxorubicin chemotherapy. Large dogs with any form of cancer
responsive to doxorubicin chemotherapy are eligible, including
those already on doxorubicin. Some breed or patient exclusions
may apply.
Contact Dr. Andi Flory at (760) 466-0600 or (858) 875-7500
Oncology – Canine Lymphoma Trial
We are now accepting enrollment for dogs with multicentric
lymphoma in several trials.
Contact Dr. Brenda Phillips at (858) 875-7500
Oncology – Quality of Life for Cats with GI Lymphoma
This is a trial that will lead to the design of a validated quality
of life survey tool for cats with GI lymphoma. This will enable the
profession to study different interventions that may impact quality
of life. Clients will be required to fill out survey information to
develop this tool. If you have an UNTREATED cat with GI lymphoma (or suspect GI lymphoma), they are eligible to participate.
Contact Drs. Brenda Phillips or Keith Richter at (858) 875-7500
For more details about these and other clinical trials, please visit our website at www.vshsd.com.
Announcements
save the date
Dr. Blaise Burke will be delivering a research abstract in May at the
annual meeting of the European Society of Veterinary Oncology in
Krakow, Poland. The abstract, titled “Prognostic Factors in Canine
Patients Treated with Definitive and Palliative Radiotherapy”, is
based on information from patients treated here at VSH. Dr. Burke
will also be lecturing over two days to the faculty and students at
the Nantes-Atlantique Veterinary College in Nantes, France. He will
be covering the principles and practice of radiation therapy with
special attention to side effects and long-term outcomes.
May 17, 2015 – VSH 5th Annual Symposium
8:00 am - 4:30 pm at the University of San Diego
Keynote: Dr. Danny Scott of Cornell University, renowned
expert in Dermatology.
Multiple Educational Tracks for Veterinarians, Technicians, Managers and
Client Care Specialists
Dr. Brenda Phillips, one of our medical oncologists, is pleased to join
the Community Advisory Board at the Sanford-Burnham Institute.
She will join other individuals on the board who are passionate
about educating the public about cancer and the world class cancer
research being conducted at Sanford-Burnham. Please join Dr.
Phillips and the other CAB members at the Institute open house for
the public in La Jolla on June 11. This is a spectacular, firsthand
opportunity for you to see cancer studies in action.
Specialists Drs. Keith Richter, Steve Hill and Kate Arnell, along with
residents, Drs. Lauren Cochran and Alexandra Hamilton attended the
2015 Comparative Gastroenterology Society’s (CGS) GutSea meeting
in Belize, Central America in March. Drs. Hamilton and Cochran each
presented research abstracts. Dr. Cochran’s was titled Evaluation of
canine pancreas-specific lipase concentrations in dogs with
gastrointestinal foreign bodies, while Dr. Hamilton presented: Serum
markers of vitamin B metabolism in cats with hepatic lipidosis.
Hurry - There’s Still Time to Register! Visit www.vshsd.com for details.
WE’RE LISTENING
Thanks to everyone who participated in our annual survey. One
consistent theme is to ensure that each and every client experience
in our hospital is at the highest level possible. Your client’s experience should match the quality of medicine we provide and we are
already taking steps to make sure this happens. You will soon receive
a communication that summarizes all the key findings and our
next steps.
Dr. Steve Hill will be speaking on liver, pancreas and GI topics at the
AIVPA International Congress/SIVOY International Symposium in
Bologna, Italy April 11th-13th.
Canine Laryngeal
Paralysis: The
Inspiration AND
the Aspiration
IN THIS ISSUE:
Cytology Versus Biopsy:
Comparisons of Accuracy — PART 2
Dr. Keith Richter was the Hepatobiliary Section Editor, and Drs. Hill,
Phillips, and Pike wrote chapters in the newest edition of Veterinary
Clinical Advisor. Dr. Richter is also writing 2 chapters for the
upcoming edition of Ettinger’s Textbook of Internal Medicine.
For more information on Continuing Education events,
please visit vshsd.com/Veterinarians or contact Ann Ong
at (858) 875-7544 or [email protected].
Clinical Trials
Upcoming Events
SAN DIEGO 10435 Sorrento Valley Rd San Diego, CA 92121 | NORTH COUNTY 2055 Montiel Rd San Marcos, CA 92069 | www.vshsd.com
In Our Community
Please join us in support of the following organizations and be
sure to stop by the VSH booth and say “Hi.”
Saturday, May 9
San Diego Humane Society Walk for Animals
Liberty Station
San Diego
San Diego: 858 875 7500
San Marcos: 760 466 0600
Sunday, June 7
RB Alive” Street Fair
Bernardo Center Drive
Rancho Bernardo
TAKE NOTE
cURRENT CLINICAL TRIALs
Internal Medicine –Gastrointestinal Foreign Body (FB)
and Pancreatitis Study
VSH (Sorrento Valley and San Marcos) is now enrolling dogs with
gastrointestinal FBs for evaluation of SNAP and Spec cPL values at
various phases during diagnosis and removal of the FB. Dogs must
have a confirmed FB removed via endoscopy or surgery. All cases
will have funded SNAP and Spec cPLs at several time points.
Clients will also receive a no charge recheck appointment and cPLs.
Contact Drs. Lauren Cochran or Steve Hill at (858) 875-7500
Internal Medicine – Feline Hepatic Lipidosis Study
Now enrolling cats with confirmed hepatic lipidosis (HL) with the
objective of evaluating vitamin-B metabolism and lipid profiles
associated with this disease process. This is a 4-week prospective
study which requires whole blood and urine collected at the time of
diagnosis and at 2 and 4 week rechecks. The objective of this study
is to expand our understanding of vitamin-B and lipid metabolism
in cats with HL. Patients that have received cobalamin or folic acid
supplementation within 8 weeks prior to diagnosis of HL may not
be included in this study (supplementation is permitted following
receipt of the first samples at the time of diagnosis).
Contact Drs. Alexandra Hamilton or Steve Hill at (858) 875-7500
Internal Medicine – Canine IBD and Probiotic VSL#3
We are enrolling dogs with chronic gastrointestinal signs that are
suspected of having idiopathic inflammatory bowel disease (IBD).
Endoscopy will be performed, and if IBD is confirmed, dogs will be
randomized to receive treatment with prednisone and diet, or
prednisone, diet and probiotic VSL#3. This is an 8-week study
requiring two endoscopic procedures. The cost of the initial
workup is partially funded and the cost of the probiotic and the
second endoscopy will be fully funded.
Contact Dr. Steve Hill at (858) 875-7500 x702
CONNECTED
10435 Sorrento Valley Rd
Suite 100
San Diego, CA 92121
Y o u r L i n k t o V e t e r i n a r y S P E C IA L T Y H O S P ITA L | A P R – J UN 2 0 15
Sunday, April 26
At the FACE Foundation’s 5th Annual Bags &
Baubles fundraiser, a fashion-loving crowd will
have the chance to bid on new and “gently
loved” handbags, jewelry and accessories at a
beautiful, private Rancho Santa Fe estate! Guests
can enjoy a wonderful opportunity drawing,
estate tours and delicious wine, appetizers and
desserts…all to benefit pets in need of critical
veterinary care! Event tickets start at just $10.
www.bagsandbaubles.org
Internal Medicine – Glomerular Disease Study
VSH is participating in a multi-center prospective study
evaluating increased dosing of enalapril in dogs with glomerular
disease. Client incentives include reduced cost of some initial
testing and no cost for scheduled recheck visits and tests.
Contact Dr. Julie Fischer at (760) 466-0600
Oncology – Conditionally Licensed Monoclonal Antibody + CCNU
Chemotherapy for Dogs with T-Cell Lymphoma
The Veterinary Specialty Hospital of San Diego is currently
enrolling cases in a nationwide clinical trial to evaluate a monclonal antibody that is conditionally licensed by the USDA to aid
in the treatment of dogs with lymphoma. The study is designed to
assess the benefit of adding the antibody to a single-agent CCNU
chemotherapy protocol for dogs with intermediate to high grade
T-cell lymphoma. The trial will pay to screen dogs with lymphoma
to determine whether they have T-cell lymphoma in order to be
eligible for the trial.
Contact Dr. Brenda Phillips at (858) 875-7500
Oncology – Funded Trial for Dogs with Cancer
Clients enrolling and completing a study evaluating the use of a
probiotic along with chemotherapy will receive funding toward
doxorubicin chemotherapy. Large dogs with any form of cancer
responsive to doxorubicin chemotherapy are eligible, including
those already on doxorubicin. Some breed or patient exclusions
may apply.
Contact Dr. Andi Flory at (760) 466-0600 or (858) 875-7500
Oncology – Canine Lymphoma Trial
We are now accepting enrollment for dogs with multicentric
lymphoma in several trials.
Contact Dr. Brenda Phillips at (858) 875-7500
Oncology – Quality of Life for Cats with GI Lymphoma
This is a trial that will lead to the design of a validated quality
of life survey tool for cats with GI lymphoma. This will enable the
profession to study different interventions that may impact quality
of life. Clients will be required to fill out survey information to
develop this tool. If you have an UNTREATED cat with GI lymphoma (or suspect GI lymphoma), they are eligible to participate.
Contact Drs. Brenda Phillips or Keith Richter at (858) 875-7500
For more details about these and other clinical trials, please visit our website at www.vshsd.com.
Announcements
save the date
Dr. Blaise Burke will be delivering a research abstract in May at the
annual meeting of the European Society of Veterinary Oncology in
Krakow, Poland. The abstract, titled “Prognostic Factors in Canine
Patients Treated with Definitive and Palliative Radiotherapy”, is
based on information from patients treated here at VSH. Dr. Burke
will also be lecturing over two days to the faculty and students at
the Nantes-Atlantique Veterinary College in Nantes, France. He will
be covering the principles and practice of radiation therapy with
special attention to side effects and long-term outcomes.
May 17, 2015 – VSH 5th Annual Symposium
8:00 am - 4:30 pm at the University of San Diego
Keynote: Dr. Danny Scott of Cornell University, renowned
expert in Dermatology.
Multiple Educational Tracks for Veterinarians, Technicians, Managers and
Client Care Specialists
Dr. Brenda Phillips, one of our medical oncologists, is pleased to join
the Community Advisory Board at the Sanford-Burnham Institute.
She will join other individuals on the board who are passionate
about educating the public about cancer and the world class cancer
research being conducted at Sanford-Burnham. Please join Dr.
Phillips and the other CAB members at the Institute open house for
the public in La Jolla on June 11. This is a spectacular, firsthand
opportunity for you to see cancer studies in action.
Specialists Drs. Keith Richter, Steve Hill and Kate Arnell, along with
residents, Drs. Lauren Cochran and Alexandra Hamilton attended the
2015 Comparative Gastroenterology Society’s (CGS) GutSea meeting
in Belize, Central America in March. Drs. Hamilton and Cochran each
presented research abstracts. Dr. Cochran’s was titled Evaluation of
canine pancreas-specific lipase concentrations in dogs with
gastrointestinal foreign bodies, while Dr. Hamilton presented: Serum
markers of vitamin B metabolism in cats with hepatic lipidosis.
Hurry - There’s Still Time to Register! Visit www.vshsd.com for details.
WE’RE LISTENING
Thanks to everyone who participated in our annual survey. One
consistent theme is to ensure that each and every client experience
in our hospital is at the highest level possible. Your client’s experience should match the quality of medicine we provide and we are
already taking steps to make sure this happens. You will soon receive
a communication that summarizes all the key findings and our
next steps.
Dr. Steve Hill will be speaking on liver, pancreas and GI topics at the
AIVPA International Congress/SIVOY International Symposium in
Bologna, Italy April 11th-13th.
Canine Laryngeal
Paralysis: The
Inspiration AND
the Aspiration
IN THIS ISSUE:
Cytology Versus Biopsy:
Comparisons of Accuracy — PART 2
Dr. Keith Richter was the Hepatobiliary Section Editor, and Drs. Hill,
Phillips, and Pike wrote chapters in the newest edition of Veterinary
Clinical Advisor. Dr. Richter is also writing 2 chapters for the
upcoming edition of Ettinger’s Textbook of Internal Medicine.
For more information on Continuing Education events,
please visit vshsd.com/Veterinarians or contact Ann Ong
at (858) 875-7544 or [email protected].
Clinical Trials
Upcoming Events
SAN DIEGO 10435 Sorrento Valley Rd San Diego, CA 92121 | NORTH COUNTY 2055 Montiel Rd San Marcos, CA 92069 | www.vshsd.com