Monday, October 22, 2018

Topics in Companion Animal Dentistry-Finding the Answer-Gingival Hyperplasia #DrDonDeForge

Donald H DeForge, VMD
Silvers Sands Veterinary
Milford Veterinary Hospital-Urgent and General Care
17 Seemans Lane-Milford, CT-06460
P 203-877-3221
F-203-877-8301
E-Mail-DonDeForge100@gmail.com
Centers for Oral Care
Tri-State Advanced Oral Medicine and Oral Surgery
Fellow of the Academy of Veterinary Dentistry
No. 28






Topics in Companion Animal Dentistry:
Gingival Hyperplasia
and Radiosurgery
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Historical Background:
Gingival Hyperplasia is a common findings in Boxers, Bulldogs, Pit Bulls, and Cocker Spaniels
along with other breeds. Its etiology is not known but a genetic link to certain breeds is
suspected.  There is a proliferative and abnormal growth of gingival tissue with pseudopocket
formation. These pockets lead to attachment loss with food, hair, and debris entrapment.
This condition should never be ignored because it will lead to advanced periodontal pathology
and oral pain.
Diagnosis:
Diagnosis is with Incisional biopsy.  Gingival hyperplasia can mimic epulis; benign invasive
oral tumors; and oral malignancies.  It is essential to biopsy to rule out oral cancer.


Medicine Induced Gingival Hyperplasia:
Certain families of medicines can cause gingival hyperplasia.  Diphenylhydantoin;
Cyclosporine; and Calcium Channel Blockers can induce gingival hyperplasia.  
Not all patients on these drugs develop gingival hyperplasia. If a patient does have gingival
hyperplasia treatment alternatives for the condition under care must be scrutinized.


Treatment Choices:
The goal of treatment is the surgical removal of proliferative tissue restoring normal gingival
contour.  Cold steel; laser; and radiosurgery [4.0 MHz] are the surgical cutting choices. It is
my opinion that only radiosurgery should be utilized for the following reasons:
Radiosurgery~~~High Frequency 4.0 MHz*
  • Permits hemorrhage control with a clear surgical field of vision
  • It prevents seeding of bacteria into the incision site
  • It permits planing of soft tissue
  • It eliminates scar tissue formation
  • It minimizes post-operative discomfort and re-treatments
  • It has a pressureless cut with a “paint-brush”-like stroke
*If your patient has a pacemaker or an Implantable Cardioverter Defibillator [ICD] your
veterinary cardiologist must be consulted prior to the use of radiosurgery.


The Procedure:
Incisional Biopsy can be done before or during the procedure if the owner does not wish two
anesthesia visits.  Pre-Anesthesia testing is completed prior to anesthesia.
Gas Inhalation anesthesia only
Pre and post treatment oral photography is advised
Full mouth oral radiology must be completed prior to removal of hyperplastic gingiva to isolate
other co-existent oral pathology. Client consultation is compulsory with Informed Consent
before treating other pathologies.
Under general inhalation anesthesia periodontal Ligament Blocks are initiated~~~
[not regional] using Articaine/Septocaine-total dosage is weight dependent
A fully rectified 4.0 MHz waveform using a Vari-Tip 118 electrode for surgical removal of the
hyperplastic tissue, is initiated, with an inverse bevel gingivectomy followed by a ginigvoplasty
A complete Piezoelectric ultrasonic root planing is completed after gingivoplasty
Tincture of myrrh and benzoin is the recommended postoperative dressing


Follow-Up Care:
A soft diet is recommended for 30 days
All hard chew materials are removed from consideration
Plaque control is essential to assist in post care recovery
Rechecks are monthly for 6 months
Regrowth of gingival tissue is minimal with excellent periodontal care of the patient
professionally along with homecare anti-plaque topicals.
Questions about this blog?
Contact Dr. DeForge at: DonDeForge100@gmail.com

Tuesday, October 16, 2018

In Search of Compassion Care-Donald H DeForge, VMD

Donald H DeForge, VMD
www.SilverSandsVeterinary.com
1-800-838-3368
Medical Director Silver Sands Veterinary; House Calls for Pets Silver Sands and
Centers for Oral Care-Tri-State Referrals in Oral Medicine and  Oral Surgery
Fellow of the Academy of Veterinary Dentistry
President of the Society for Veterinary Medical Ethics
#DrDonDeForge
#SilverSandsVeterinary



Image result for Picture of a veterinarian holding a pet in their care



In Search of Compassionate Care
D. DeForge, VMD

The below essay was written by Mara Fionese and Stefano Alice-Family Medicine.
Take a moment and read it carefully. 

As President of the Society for Veterinary Medical Ethics, I seek to bring the words of the Royal College of General Practitioners motto to veterinary medicine:
Cum Scientia caritas-Compassion and Knowledge.

I begin, today, a campaign to make veterinary medical care more compassionate!  

Veterinary medical students and human medical students become demoralized by an impersonal system before they begin their journey.  

This is a pedagogical mistake due to a depersonalizing education system: unconcerned and unable to give full support to students, leaving them alone and without a role model. 

As Fionese and Alice state:  Compassion isn't a single, sympathetic utterance, but is rather made up of presence and engagement that suffuses an entire conversation.

Rollo May, psychologist and theologian, applies the Greek word “agape” or the Latin “caritas” to compassion to underline what is essential in a therapeutic relationship: an emotion of regard and affection (it applies to both “agape” and “caritas”). He shares the Royal College of General Practitioners’ (RCGP) point of view, whose motto is: “Cum Scientia caritas - Compassion with Knowledge”. It all seems to fit.

If you were to comb through scientific literature, you may notice that there’s something capable of reducing post-operative pain, boosting the survival chance of cancer patients, lowering the mortality rate in high risk cardiac patients and cutting the hospitalization rate for diabetics. As if that wasn’t enough, it also boosts the immune system.

So what is this mysterious substance? It’s compassion, or better still, compassionate doctors. Before you stop reading, don’t make the mistake of confusing compassion with pity or commiseration.

Compassion isn't a single, sympathetic utterance, but is rather made up of presence and engagement that suffuses an entire conversation.

The importance of compassion may unsettle doctors who think their duty is to be technically proficient and up-to-date, those who think that it’s a natural quality you either have or don’t have, as well as certain ethicists who think that doctors need to maintain a professional distance from their patients.  [Not all ethicists believe this-D DeForge, VMD]

But it is central to the welfare of patients. Dr. Robert Youngson, an anaesthesiologist, has launched a campaign to make healthcare more compassionate. According to his research, there are two type of doctors who fit the profile:
1) Empathetic doctors: those who naturally grasp that the whole point of empathy is to focus attention on the patient.
2) Doctors who have successfully attended a doctor patient communication skills course. Communication skills can be taught.

For example, a good technique for showing compassion, is simple: 3 T’s. Talk or listen, take time and touch. Merely taking the time to talk and listen to patients is comforting, as is a doctor’s touch.

Moreover, we must leave our empathetic abilities to guide us through our work, we should develop our compassion as a gift everyone can use.

How many doctors have become cold and distant after losing their freedom and being forced to work as small cogs in a big machine? How many students have become unenthusiastic or demotivated before even getting their medical degree? This is a pedagogical mistake due to a depersonalizing education system: unconcerned and unable to give full support to students, leaving them alone and without a role model.

Scientific literature proves that this argument can be applied both to single professionals and organisations. Personality, values and behaviour reflect individual performances, which are the road to failure or success for each organisation. The doctor-patient relationship is part of the healing process

Biologically speaking, empathy can be explained by "Mirror neurons." These are a type of brain cell that fires when someone performs an action, and also when a person watches someone else performing the same action.

They were discovered back in the 90s, by a team of Italian researchers who found individual neurons in the brains of monkeys that fired both when the monkeys grabbed an object and also when the monkeys watched another primate grab the same object.

But mirror neurons also exist in the brain areas that are in charge of emotions.
This means that we are able to recognize other people’s emotions simply by observing them. When we observe someone, these mirror neurons are activated and allow us to at least partly feel the emotions that the person we are observing is feeling.

These “empathic” mirrors are triggered both when we experience an emotion and when we observe somebody who is experiencing the same emotion. This extraordinary achievement provides the neurophysiological grounds for empathy.

“It’s the relationship that heals”, says Dr. Irvin D. Yalom, Psychiatry professor at Stanford University; he underlines the importance of qualitative relationships over theory. A relationship is strictly personal, a good relationship is based on care and the will to relieve patients’ suffering.

According to the American psychologist Carl Rogers, there are three main ingredients to a good doctor-patient relationship: empathy, honesty and genuineness.

Rollo May, psychologist and theologian, applies the Greek word “agape” or the Latin “caritas” to compassion to underline what is essential in a therapeutic relationship: an emotion of regard and affection (it applies to both “agape” and “caritas”). He shares the Royal College of General Practitioners’ (RCGP) point of view, whose motto is: “Cum Scientia caritas - Compassion with Knowledge”. It all seems to fit.

If we work on patient-centered care, if the patient himself feels that he’s taken seriously and the doctor addresses his needs, this will lead to reduced healthcare waste.

Our purpose is to stimulate a debate on how to improve medical training, given the positive results of the researches; a debate on being both up-to-date and compassionate.

At the edge of the Fourth Industrial Revolution, a wave of digital-era change, compassion is still a valuable tool for those who want to shape innovations rather than being overwhelmed by them.

Read the words of this age-old song from Disney.  Then reflect on how compassionate care can enter into your life today!

When a star is born
They possess a gift or two
One of them is this
They have the power to make a wish come true
When you wish upon a star
Makes no difference who you are
Anything your heart desires will come to you
If your heart is in your dream
No request is too extreme
When you wish upon a star
As dreamers do
Fate is kind
She brings to those who love
The sweet fulfillment of their secret longing
Like a bolt out of the blue
Fate steps in and sees you through
When you wish upon a star
Your dreams come true
When you wish upon a star
Makes no difference who you are
Anything your heart desires will come to you!


Questions on this blog?
Write #DrDonDeForge at:  DonDeForge100@gmail.com

Thursday, October 4, 2018

CAT STOMATITIS-THERE IS A CURE-Topics in Animal Dentistry- www.SilverSandsVeterinary.com-#DrDonDeForge




www.SilverSandsVeterinary.com
P 1-800-838-3368
E-Mail: DonDeForge100@gmail.com
Centers for Oral Care
The New York and New England Animal Dental Health Services
Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
President of the Society for Veterinary Medical Ethics




Image result for picture of cat in pain





CAT STOMATITIS!

THERE IS A CURE!


Attention: Doctors,Veterinary Nurses, and Stomatitis Cat advocates.

Today’s Topic in Animal Dentistry outlines my oral surgery using GBR to cure cats from stomatitis.  It is the only surgery to date that can bring complete resolution without remission.


Questions can be directed to DonDeForge100@gmail.com or you can call me at 1-800-838-3368.


 Introduction:  Topic In Animal Dentistry #1

The classic treatment of feline Stomatitis with whole mouth extraction or extraction of the teeth distal to the canine teeth has proven to be non-productive in half of the patients treated.

Any where between 50-65% of these felines have only short term improvement with a return of the oral inflammatory condition in 6 to 18 months.  On the other hand, the alternative surgery, herein described, utilizing Guided Bone Regeneration and radiosurgery to create full thickness mucoperiosteal flaps…… i.e. osseous surgery combined with bone augmentation has proven to be completely successful. 
 
Guided Tissue Regeneration (GTR) 
Refers to procedures that attempt to regenerate lost periodontal structures, such as bone, periodontal ligament and the connective tissue attachment that support our teeth. This is accomplished using biocompatible membranes, often in combination with bone grafts or tissue stimulating proteins. 

Guided Bone Regeneration (GBR) 
Refers to procedures that attempt to regenerate bone. This is accomplished using bone grafts and biocompatible membranes that keep out tissue and allow the bone to grow. 

In the Journal of Veterinary Dentistry, Vol 14, No. 4-Dec 1997-Evaluation of Bioglass®/PerioGlas™ [Consil®] Synthetic Bone Graft Particulate in the Dog and Cat-DH DeForge, VMD -GBR is described. 
Bioglass® Synthetic Bone Graft Particulate [PerioGlas™/Consil™] was utilized to treat osseous periodontal defects, and in post-extraction sites to maintain the vertical height and width of the alveolar ridge.  In the osseous periodontal defect treatment group, clinical probing depths deceased significantly, and there was an apparent gain in attachment level.  This synthetic bone graft particulate improves the rate of osseous growth while being resorbed and replaced with bone during the healing process.

This original work led to the utilization of Consil®/Bioglass®, synthetic bone graft particulate, in a feline stomatitis surgery technique I developed.
 When implanted in stomatitis felines, a material surface reaction results in the formation of a calcium phosphate layer that is similar in composition and structure to the hydroxyapatite found in bone mineral.  This apatite layer provides the scaffolding onto which the patient’s new bone will grow allowing repair of the bone defects in feline oral stomatitis.  Diseased bone is removed and new bone is created to allow the patient to fully recover from the inflammation and pain caused by the pre-surgical oral pathology.
  
The hypothesis that the cats affected with stomatitis suffer from a bone disease rather than a dental disease has been confirmed  with this new surgical approach to the disease. The confirmation is the actualization of complete and permanent clinical improvement after GBR surgery in the edentulous patient [i.e. patients having had earlier whole mouth extraction surgery by other surgeons prior to referral to me]. In these felines, where the whole mouth extraction technique had failed, GBR Feline Stomatitis Surgery succeeds confirming the origin of the pathology as a bone-centered pathology.

Before patients can be treated utilizing radiosurgery combined with GBR, comprehensive pre-anesthetic screening must be completed. An incisional biopsy is performed to rule out other causes of oral pathology including oral cancer.  An Esophagostomy tube must be placed two weeks prior to GBR Stomatitis Surgery.

This surgery has been utilized by me for over a decade with ONLY POSITIVE results.  After all of this time, animal oral surgeons are now starting to acknowledge in their lecturing and manuscripts in journals that cat stomatitis may have a bony component. The wheel of surgical change moves slowly!

Contact Dr. DeForge about an in gratis exam!

Dr. Don DeForge
Fellow of the Academy of Veterinary Dentistry
President of the Society for Veterinary Medical Ethics
04October2018

Wednesday, September 5, 2018

Anesthesia Safety for the Pet You Love #DrDonDeForge #SilverSandsVeterinary





Donald H. DeForge, VMD
Silver Sands Veterinary
Milford Veterinary Hospital
17 Seemans Lane
Milford, CT 06460
P-203-877-3221
E-Mail DoctorDeForge@yahoo.com
DonDeForge100@gmail.com
www.SilverSandsVeterinary.com

NEVER NEVER LAND
It might be miles beyond the moon,
Or right there where you stand.
Just keep an open mind,
And then suddenly you'll find
Never Never Land.
You'll have a treasure if you stay there,
More precious far than gold.
For once you have found your way there,
You can never, never grow old.
And that's my home where dreams are born,
And time is never planned.
Just think of lovely things.
And your heart will fly on wings,
Forever in Never Never Land.


A Safe Journey for Your Pet Under Anesthesia





Pre-Anesthesia Examination and Testing Requisites-American College of Veterinary Anesthesia- Monitoring Guidelines

Companion animal advocates are very concerned when

 the pet that they love needs to undergo general

 inhalation anesthesia for any reason.

 
The ultimate goals of veterinary preoperative medical

 assessment and human preoperative assessment are

 identical.  The goal of exam and testing is to reduce the

 patient’s surgical and anesthetic peri-operative

 morbidity or mortality, and to return the patient to

 normal functioning and a pain free quality of life as

 quickly as possible.


 It is imperative to realize that anesthesia risk and

 recovery from anesthesia risk is multi-factorial and a

 function of the preoperative medical condition of the

 patient; the invasiveness of the surgical procedure; and

 the type of anesthetic administered.


A history and physical examination is critical with

 emphasis on risk factors for cardiac and pulmonary

 complications.  Laboratory investigations must be

 ordered based on the patient’s age; medical status; drug

 therapy; or the nature of the proposed procedure.

 Those veterinary patients with co-morbidity should be

 optimized for the procedure.  Proper consultations with

 appropriate medical specialists should be scheduled to

 improve the patient’s health prior to anesthesia if

 indicated.


These consultations should ideally not be done in a "last

 second" fashion. The pre-operative preparation involves

 procedures that are implemented based on the nature of

 the expected operation as well as the findings of the

 diagnostic workup and the pre-operative evaluation.

 The referring doctor-LDVM-RDVM-can spear head and

 complete all exams and testing or refer to a specialist

 for that testing.

 Listed below are many of the tests that the LDVM or

 Specialist may order based on the age of the patient;

 pre-existing medical health of the patient; and/or othe

 factors noted in past Medical Records.  It is critical to

 know if any patient referred has had any adverse history

 with anesthesia, sedation, and/or analgesic medicines i

 the past.

The Pre-Anesthesia Testing  Module choices will be determined by the veterinarian or anesthesiologist that will be anesthetizing the friend that you love.  Not all of the testing below is performed on each patient.  Discuss your doctor's testing choices based on age; past anesthesia history; any present medical problems; the obese state; or present problems being treated.

Pre-Anesthesia Testing Modules
 [          } Physical Exam

[          ] Comprehensive Chemistry Profile and CBC

[          ] Urinalysis

[          ] Feline Leukemia-Immunodeficiency-and Bartonella Testing at National Veterinary Lab

[          ] CardioPet proBNP / Feline *

[          ] SDMA Biomarker for Kidney Function (IDEXX Adult Wellness

[          ] Blood Pressure

[          ] Coagulation Testing [PT/PTT/BMBT]

[          ] Electrocardiogram

[          ] Chest Radiology

[          ] Echocardiogram

[          ] Abdominal Sonogram

[          ] Internal Medicine Consult and Pre-Anesthesia Testing

[          ] Cardiologist Consult


Common Questions Asked about Animal Anesthesia:

1] Are anesthesia complications common?

There are horror stories on the internet that just are not fact.  

Some internet sites offer reliable and useful information from

veterinary specialists....many others contain inconsistencies 

and flat out falsities.  Don't be fooled by misinformation.  Do 

research on anesthesia; read articles from veterinary univer-

sity sources and discuss your findings with your local doctor

of veterinary medicine.  This will rid your mind of a few 

unfounded fears.  A well trained veterinary team will take

every reasonable precaution including state of the art

monitoring equipment with trained veterinary nurses for

patient evaluation under anesthesia.


2] The drugs my doctor uses for anesthesia may hurt my

 pet?

Sit down with your LDVM and have them describe all

of the drugs to be used and why they have been

selected.

The veterinarian chooses an anesthesia protocol

to meet each patient's needs based on the patient's

procedure; time predicted under anesthesia; the age of the

patient; other medical conditions present prior to anesthesia;

and general overall health of your pet.  Don't forget to ask 

about the monitoring equipment and how your pet is 

recovered after anesthesia.


Don't let friends, gossip, or the internet prevent your pet

from receiving necessary care with general anesthesia.

Let your doctor be your guide!



Dr. DeForge welcomes questions to his blogs at 

DonDeForge100@gmail.com

Friday, August 24, 2018

Never Never Land-Poisonings in Companion Animals #DrDonDeForge #SilverSandsVeterinary




Donald H. DeForge, VMD
Silver Sands Veterinary
Milford Veterinary Hospital
17 Seemans Lane
Milford, CT 06460
P-203-877-3221
E-Mail DoctorDeForge@yahoo.com
DonDeForge100@gmail.com
www.SilverSandsVeterinary.com

NEVER NEVER LAND
It might be miles beyond the moon,
Or right there where you stand.
Just keep an open mind,
And then suddenly you'll find
Never Never Land.
You'll have a treasure if you stay there,
More precious far than gold.
For once you have found your way there,
You can never, never grow old.
And that's my home where dreams are born,
And time is never planned.
Just think of lovely things.
And your heart will fly on wings,
Forever in Never Never Land.





Image result for Picture of a poisoned Pet

Dr. DeForge shares today the common poisonings noted on the ASPCA Pet Poison Hot Line.
This BLOG could save your Pet's Life!

ASPCA Poison Control
Top Ten Poisonings Noted in Companion Animals
Animal Poison Control Center
24 Hour Emergency Veterinary Poison Hotline
888-426-4435

Descending Order Based on 2017 Data:

10. Garden products. In line with last year’s results, we saw that garden products remained in the same #10 spot, accounting for 2.6% of APCC’s cases. Many pets find fertilizers and other gardening-related products irresistible. Make sure your pets are contained when you are working in the garden with herbicides and soil enhancement products.
9. Plants. Plants remained in ninth place with 5.4% (10,725) of APCC’s cases. Throughout 2017, landscaping plants, houseplants and bouquets were all sources of potential problems for pets. Lilies (Lilium sp and Hemerocallis sp.) in particular pose a serious danger for cats, while Sago Palm and Oleander plants continue to be a serious danger for both dogs and cats.  
8. Rodenticides. Rodenticide exposures made up 6.3% of cases in 2017, an increase when compared to last year. The unpredictable weather patterns last year had rodents seeking shelter and food inside homes, leading to an increase in these preventative poisons. It’s important to remember that rodent poisons can be just as toxic to pets as they are to the pests they’re designed to kill.  
7. Insecticides. Insecticide exposure cases continued to decrease from 2016, with only 6.7% of cases (13,307) related to these items. If the directions on the label are not followed, these products can be dangerous to pets, so always use caution when dealing with insect poisons.  
6. Household items. Household items dropped one spot from last year comprising 8.6% of cases in 2017. Household items include paint, glue, cleaning products and laundry detergent, among others. With this group, proximity to pets’ environment is a common reason for exposure. Laundry pods, which made the news this year, are an up and coming danger in this group. It’s important to be mindful about keeping your pets away when using cleaning products or doing your laundry.
5. Chocolate. Chocolate toxicity made up 8.8% (17,540) of APCC cases. That works out to over 48 cases a day! While chocolate is a food, APCC gets so many calls about chocolate that it gets its own spot on the top 10 list. Dogs in particular are “chocolate fiends,” and with their good sense of smell, they are very good at finding it. Also, the popularity of chocolate as gifts for holidays like Christmas, Valentine’s Day and Easter only increases the chance for pets to get into it.  
4. Veterinary products. Veterinary products made up 8.9% of cases seen. Flavored and chewable medications make it easier for our pets to take a pill, but this also means they may eat the entire bottle if they find access to them—leading to a potential overdose and complications.
3. Food. People food comes in at number three with 10.9% of cases (21,648) in 2017. Pets cannot safely ingest all of the same food items humans can. Grapes and raisins, onions and garlic (Allium sp.), avocados, macadamia nuts, alcohol, raw yeast bread dough and xylitol are all different types of foods that can be dangerous for pets.  The popularity of xylitol in sugar-free items like gum and baked goods has continued to keep this group near the top of the list.  
2. Over-the-counter (OTC) medications. OTC medications made up 17.4% of APCC cases in 2017.  Like last year, OTC medications came in second place in the top 10 list.  This is a diverse group of items such as vitamins, pain medications (acetaminophen, ibuprofen, and naproxen), herbal supplements, probiotics, antihistamines and cold and flu medications. As with human prescription medications, most exposures are accidental. Making sure pet owners are educated about how to keep these out of pets’ reach and checking with a veterinarian prior to giving an OTC medication to a pet is important. 
1. Human prescription medications. Prescription medications tops the list! Last year, 17.5% (34,888) of APCC cases were attributed to prescription meds. This group contains a wide range of medications, but pain medications, antidepressants and heart medications are the most common medications APCC receives calls about. Ingestion of the medications is typically accidental. However, pet owners unintentionally giving the wrong medication also occurs.   
With any potential dangers and toxins, it is important to keep these things out of paws’ reach. While accidents can always happen, the less accessible any of the items are, the less likely your pet is to get into them. To help you stay up-to-date on potential pet toxins or dangers, download the APCC Mobile App today!
If you suspect your pet has been exposed to any poisonous substances, contact your veterinarian or call Animal Poison Control Center (APCC) at 888-426-4435 immediately.

Topics in Companion Animal Dentistry-Finding the Answer-Gingival Hyperplasia #DrDonDeForge

Donald H DeForge, VMD Silvers Sands Veterinary Milford Veterinary Hospital-Urgent and General Care 17 Seemans Lane-Milford, CT-06460 P 2...