Contents of Today's Veterinary Practice - JAN-FEB 2012

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

Page 9 of 83

LETTERS TO THE EDITOR
A Unique Journal Presents Unique Therapies
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ongratulations on the premier issue of Today's Veterinary Practice! It is a unique, informative contribution
to the practitioner. I found it particularly interesting to see some of the old, lost arts of treatments featured (Unique Thera- pies for Difficult Wounds]Ê ÕlÞÉ Õ}ÕÃÌÊ 2011, page 10). I have seen many valuable, traditional practices lost over the years. I have a question: On page
15 of this article, in the box ÌiÌli`Ê >kin}Ê >kin½ÃÊ-olÕÌionÊ (0.5%), step 2 says "Remove the pan from the heat" and then step 3 says, "Using a sterile measuring spoon, add ½ teaspoon of baking soda and 3 ounces or 95 mL of bleach." Shouldn't the boiled water be cooled off prior to adding the baking soda and bleach? It seems h>â>À`oÕÃÊ ÌoÊ >``Ê ÌhoÃiÊÕnÃÌ>LliÊ compounds to hot water. /h>nkÊÞoÕÊvoÀÊ>``ÀiÃÃin}ÊmÞÊ
question. Again, congratulations to all the editorial staff and editorial board members. Wishing you all continued success in this very worthwhile publication. It is a breath of fresh air in the field of veterinary literature for practitioners.
Anthony Miceli, BSc, DVM Wildwood Animal Clinic Fowlerville, Michigan
Authors Respond Great question—thank you for allowing ÕÃÊÌoÊVl>ÀivÞÊÌhiÊ«ÀoViÃÃÊovÊm>kin}Ê >kin½ÃÊ solution. While we do not recommend >``in}ÊiÌimÃÉin}Ài`iinÌÃÊÌoÊÀollin}ÊLoilin}Ê water, keeping the water tepid will help dissolve the baking soda. We always encourage people to use caution when pouring liquids to avoid splattering or ëillin}Ê>nÞÊhoÌÊliµÕi`ÊoÀÊVhimiV>l°Ê/h>nkÊ you for reading the article; we are glad you found it useful!
Kristen O'Connell and Jennifer L. Wardlaw, DVM, MS, Diplomate ACVS Mississippi State University
Clarifying the Significance of Lactate Values I'm writing in reference to the Journal Club column in the ÕlÞÉ Õ}ÕÃÌÊiÃÃÕiÊovÊToday's Veterinary Practice (page 74),
specifically the commentary regarding the article Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation- volvulus: 84 dogs (2003-2007).1 /hiÊVomminÌ>ÌoÀ]Ê À°Ê,oâ>nÃki]ÊÃÌ>ÌiÃÊÌh>ÌÊ>nÊ
iniÌi>lÊl>VÌ>ÌiÊÛ>lÕiÊovÊ>Ê{°£ÊmmolÉ Ê«Ài`iVÌi`Ê`i>Ìh]Ê LÕÌÊÌhiÃÊiÃÊnoÌÊÜh>ÌÊÌhiÊ>ÕÌhoÀÃÊvoÕn`°Ê/hiÊ>ÕÌhoÀÃÊ stated that the significant value they found was an iniÌi>lÊ«l>Ãm>Êl>VÌ>ÌiÊovÊ<Ê{°£ÊmmolÉ ]ÊÜhiVhÊÜ>ÃÊ 90.9% specific for survival (not death), and only 60.3% sensitive for survival. Given that this value is specific for survival, a dog with a lactate < 4.1 mmolÉ ÊÜoÕl`ÊLiÊiÝ«iVÌi`ÊÌoÊÃÕÀÛiÛi°Ê oÜiÛiÀ]Ê since the test is not very sensitive, it would be incorrect to infer that a dog with a lactate of > {°£ÊmmolÉ ÊÜillÊnoÌÊÃÕÀÛiÛi°Ê oÀÊ À°Ê,oâ>nÃki½ÃÊÃÌ>ÌiminÌÃÊÌoÊLiÊVoÀÀiVÌ]Ê
the authors' findings would have found Ìh>ÌÊ>Ê«l>Ãm>Êl>VÌ>ÌiÊovÊ>Ê{°£ÊmmolÉ ÊÜ>ÃÊ Ã«iViviVÊvoÀÊ`i>Ìh°Ê/hiÃÊmiÃinvoÀm>ÌionÊVoÕl`Ê potentially cause clinicians to make incorrect prognostic decisions, though I would hope any
clinician would read the full article before basing any decisions onÊÃÕmm>Àiâi`ÊinvoÀm>Ìion°Ê
Noah Jones, RVT University of California–Davis
Author Responds I thank Mr. Jones for his insightful comments. I strongly agree that a single lactate value should never be used to predict death or morbidity in a dog with gastric dilatation-volvulus. /oÊVl>ÀivÞ]ÊÌhiÊ>ÀÌiVliÊÀiviÀinVi`1 found that a lactate value of <Ê{°£ÊmmolÉ ÊÜ>ÃÊ«Ài`iVÌiÛiÊovÊÃÕÀÛiÛ>l]ÊÀ>ÌhiÀÊÌh>nÊ>Êl>VÌ>ÌiÊ Û>lÕiÊovÊ>Ê{°£ÊmmolÉ ÊLiin}Ê«Ài`iV>ÌiÛiÊvoÀÊ`i>Ìh°Ê Ê>«olo}iâiÊ for the misstatement, and strongly reiterate that while helpful in assessing perfusion, an isolated lactate value, or even failure of the lactate level to return to normal should not in itself have any bearing on clinical decisions to proceed with therapy or to iÕÌh>niâiÊ>nÊ>vviVÌi`Ê«>ÌiinÌ°Ê
Elizabeth Rozanski, DVM, Diplomate ACVECC & ACVIM (Small Animal Internal Medicine) Tufts Cummings School of Veterinary Medicine
Reference
1. Green TI, Tonozzi CC, Kirby R, Rudloff E. Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation-volvulus: 84 dogs (2003– 2007). Journal of Veterinary Emergency and Critical Care 2011; 21:36–44.
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Today's Veterinary Practice January/February 2012