April 2014

P 1- Collaborative Specialty Case Study: Ascites

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P 2- Specialty Service Overview: Cardiology and Mobile Cardiology

- Did you know? Teleradiology

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P 3- Continuing Education Lunch’ N Learn: Internal Medicine

- Team Member Highlight: Dr. Janet Bailey

- Technician Tip: 1, 2, 3 ECG

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P 4- Testimonial: Ivy

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Presentation:Danny Boy, a 9-year-old neutered male Golden Retriever, was referred to DVMS’ Internal Medicine Department for evaluation of ascites. His owners had noticed that his abdomen was getting bigger, but his appetite and behavior were normal for several more weeks. In December, they noticed weight loss, intermittent vomiting, sporadic increased thirst, and moaning. When they saw their primary care veterinarian, Danny Boy had a harsh, dry cough, was showing signs of hind limb weakness, and his abdomen was significantly distended.

Diagnostics:• A diagnostic abdominocentesis revealed non-

hemorrhagic fluid, and Danny Boy was referred for further evaluation. On presentation, Danny Boy was bright, alert, and mentally appropriate. His body condition was poor with generalized muscle atrophy, abdominal distension, and his hind limbs were intermittently weak.

• Physical examination revealed a Grade I/VI left apical systolic murmur and an irregularly irregular cardiac arrhythmia with irregular femoral pulses. These findings were suggestive of a cardiac cause of ascites and thoracic radiographs were done.

• Significant findings on radiographs included mediastinal soft-tissue opacities most consistent with mediastinal lymphadenopathy. The heart was

slightly enlarged, and there was an unstructured interstitial pattern in the caudodorsal lungs.

• An echocardiogram was done, and a large 4 cm x 4 cm mass was identified that appeared to originate from the myocardium of the left ventricle and extended into the left atrium adjacent to the aorta. There was mild pericardial effusion that was not causing tamponade.

Outcome:The cardiac mass was causing both congestive heart failure (ascites) and the arrhythmia. The location of the mass in the heart was atypical and the top differential for the cardiac and mediastinal masses was lympho-sarcoma, although other types of metastatic neoplasia could not be ruled out. After discussing the findings and grave prognosis associated with the cardiac mass, Danny Boy’s owners elected humane euthanasia.

Take Away: The benefit of a collaborative approach to diagnosis and evaluation of disease allowed for a thorough understanding of Danny Boy’s condition. The expertise of the collective team, through our ensuing discussions, illuminated the effects one ailment would have on his other organs and how it would play into his overall prognosis. With an internist, cardiologist, and radiologist as part of the same specialty team, collaboration happened seamlessly, and rapidly. And although the decision to euthanize was the end result, the efficiency of care ultimately saved the owners prolonged stress and gave them peace of mind that they made the right choice for Danny Boy.

Janet Bailey, DVMDiplomate ACVIM

Collaborative Specialty Case Study: Ascites

The best diagnostic images can be completely invalid if they are interpreted incorrectly. We encourage you to utilize our radiologist, Dr. Vicki Heffelman, to interpret your imaging studies and help you make the best recommendations for treatment. She personally interprets every image and sends a detailed report to you within 24 hours.

If you would like your patients’ digital radiographic studies interpreted by Dr. Heffelman through our Teleradiology service, please call 480.635.1110 x7 and we’ll be glad to show you how to submit them through our website.

DID YOU KNOW...

With only 200 board-certified cardiology specialists in existence today, we are proud to have three of them on our team, Dr. Whit Church, Dr. Timothy Hodge, and Dr. Kathryn Atkinson. Our philosophy centers on the belief that symptoms of heart disease are treatable. Our mission is to help you provide high quality health care to your patients and successfully manage cardiac conditions.

Cardiac ConsultationsDVMS cardiologists provide complete cardiac examinations for referred patients and perform additional diagnostics, as needed, to enable comprehensive cardiovascular evaluations. Such diagnostic tests may include:

• Echocardiography • Electrocardiograms • Chest radiographs • Blood pressure evaluation

• Holter monitoring • Pericardiocentesis • Implantable EKG loop recording • OFA cardiac breed certification

EchocardiographyAs the best diagnostic tool for early detection and monitoring of cardiac disease, echocardiography allows comprehensive evaluation of valvular insufficiencies, outflow obstructions, complex congenital heart disease, and systolic pump function.

Interventional CardiologyDVMS has established a complete cardiac service that includes an interventional cardiac catheterization lab at our facility in Gilbert, located inside Arizona Veterinary Specialists. Services include:

• PDA closure • Balloon valvuloplasty • Invasive pressure measurements

• Pacemaker implantation • Angiography • Heartworm extraction

Mobile CardiologyOur mobile services include patient examination and echocardiography at your practice on Mondays, Wednesdays, and Fridays in Phoenix, and Thursdays in Tucson. If the patient requires surgery, it can be performed at our practice in Gilbert with rechecks conducted at your clinic. Please call 480.635.1110 x7 for scheduling.

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OUR CARDIOLOGISTS SERVE ALL OF ARIZONA!

SPECIALTY SERVICE: CARDIOLOGY & MOBILE CARDIOLOGY

Whit Church, DVMDiplomate ACVIM (Cardiology)

Timothy Hodge, DVMDiplomate ACVIM (Cardiology)

Kathryn Atkinson, DVMDiplomate ACVIM (Cardiology)

Our internists Janet Bailey, DVM, DACVIM and Melissa Riensche, DVM, DACVIM, offer a variety of topics on state-of-the-art diagnostic tips, treatment options, and advances being made in internal medicine, such as:

• Autoimmune Diseases • Endocrinology • Gastroenterology • Hematology • Respiratory • And Much More...

Call Practice Manager, Kathy Wilson, at 480.635.1110 x7 to arrange lunch – at your place or ours.

CONTINUING EDUCATION

LUNCH AND LEARN WITH THE SPECIALISTS:INTERNAL MEDICINE

Dr. Bailey received her veterinary medical training at Kansas State University in 2002. Following a one-year internship program at VCA South Shore Animal Hospital, Dr. Bailey continued her training with a residency in small animal internal medicine at Louisiana State University. After the completion of her residency in July 2005, Dr. Bailey relocated to Phoenix to join Arizona Veterinary Internal Medicine, now Desert Veterinary Medical Specialists. She has a special interest in infectious diseases, respiratory diseases, gastroenterology, and endocrinology.

Dr. Bailey’s commitment to advance veterinary medicine is evidenced by the many charities and associations she serves. She currently holds a seat on the board of directors of the American College of Veterinary Internal Medicine Foundation, is the Chair of the Arizona Veterinary Medical Association Public Relations Committee, and a member of the Phoenix Zoo Advisory Team.

TEAM MEMBERHIGHLIGHT

JANET BAILEY, DVM, DACVIM

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An electrocardiogram is used to evaluate heart rate, rhythm, and conduction. It is important, as a veterinary technician, to be proficient in obtaining a diagnostic ECG, calculating an accurate heart rate, and identifying normal and abnormal complexes on an ECG strip.

The patient should be placed on a towel or blanket in right lateral recumbency. Electrodes should be placed directly on skin and wet with gel or alcohol. The white lead is attached to the front right limb, the black lead is attached to the front left limb, the red lead connects to the left rear limb, and the green lead to the right rear limb. The patient should be calm and immobilized to prevent motion artifact. The trace can be run at 25mm/sec and 50mm/sec on the monitor and the size of the wave form can also be adjusted if any waveform appears too large or too small. It is also helpful to run the machine on the delay function, especially if the arrhythmia is intermittent, as to not waste a lot of paper.

A quick way to obtain a heart rate is with a bic pen. Place a capped pen at the start of a beat and count how many beats fall within the pen. If the paper speed is at 25mm/sec, multiply the number of beats by 10. If the paper speed is 50mm/sec, multiply by 20. If an arrhythmia is noted, multiple strips should be printed at both paper speeds for evaluation.

TECHNICIAN TIP

1, 2, 3 ECGDINA BERRIOCHOA, CVT

Save the Date – June 28 , 3:00pm – 8:00pm – Cardiology Symposium – Details coming soon.

We have been clients of Dr. Janet Bailey since 2008, the year our precious dog, Ivy, was diagnosed with Hepatocutaneous Syndrome, a very rare liver disease.

Over time Ivy acquired numerous other complicated medical conditions, all of which were treated by an evolving group of compassionate DVMS specialists led by Dr. Bailey. As we liked to say, Ivy was wired together with “Bailey wire.”

We are grateful to all at DVMS for their wide ranging medical expertise and unceasing dedication to helping both Ivy and now our two new senior girls, Kate and Allie.

Judy and Dick HowardCopyright © 2014 DVMS. All Rights Reserved.4

Located inside Arizona Veterinary Specialists86 W. Juniper Avenue • Gilbert, AZ 85233

Cardiology Internal Medicine Mobile Cardiology RadiologySelect Cardiology services also available in Glendale, Scottsdale, and Tucsondvmspecialists.com • 480.635.1110 x7