Page 1147 - Cote clinical veterinary advisor dogs and cats 4th

Lameness 571

• Cytologic evaluation of milk reveals cell also be beneficial when there are puppies to Prevention
counts > 3000 cells/mcL with macrophages nurse and lactation cannot be interrupted. • Provide a gradual increase of food intake
VetBooks.ir is present. Nutrition/Diet 125%-150% maintenance requirements after Diseases and Disorders
and neutrophils when inflammation (p. 618)
during the second half of pregnancy, and
Diminishing food intake (one-half) and water
whelping.
• Be sure mammary development is adequate
TREATMENT
for 2 or 3 days may help resolve galactostasis.
before cesarean section.
Treatment Overview Behavior/Exercise • Gradual weaning prevents galactostasis.
Agalactia treatment mainly consists of the • In hypogalactia or secondary agalactia, ensure • Considering the possible genetic component
administration of galactagogues (prolactin puppies suckle vigorously so that natural of primary agalactia, breeding affected bitches
increasing drugs). Treatment should be con- stimulation of the glands occurs. should be weighed against the potential of
tinued for 3 days beyond when milk production • Galactostasis may benefit from wrapping perpetuating the problem.
appears. Failure of milk letdown requires mammary area with an elastic bandage to
treatment of primary cause (pp. 618 and 854). protect from trauma. Any stimulation on the Technician Tips
Conversely, galactostasis could be treated with mammary glands (e.g., padding, touching, • Slowly and calmly introduce puppies to
prolactin-decreasing drugs (dopamine agonists or milking) should be avoided if lactation dam after cesarean section. Anxious bitches
or antiserotoninergics) if there are no puppies is going to be terminated. may benefit from mild tranquilization with
to nurse. acepromazine. (See Video.)
Drug Interactions • Galactostasis may benefit from wrapping
Acute General Treatment High metoclopramide doses (5 mg/kg) for more mammary area with an elastic bandage to
• Because primary agalactia has no effec- than 5 days usually cause behavioral side effects protect from trauma. Any stimulation of the
tive treatment, puppies should be hand such as excitation and aggression. Domperidone mammary glands (e.g., padding, touching,
reared. provokes minimal (soft stools) or no side effects. or milking) should be avoided if lactation
• Hypogalactia or secondary agalactia can be is going to be terminated.
treated with Possible Complications
○ Metoclopramide 0.1-0.2 mg/kg SQ q 6-8h When gross inflammatory changes of the Client Education
○ Domperidone 2.2 mg/kg PO q 12h for mammary glands accompany the accumulation Teach clients to recognize lactation disorders
4-6 days. Domperidone is a safer choice of milk, mastitis may be present. early so puppies can be saved.
than metoclopramide because it does not
cross the blood-brain barrier and therefore PROGNOSIS & OUTCOME SUGGESTED READING
has no central side effects. Romagnoli S, et al: Control of mammary gland
• Failure of milk letdown can be treated with Primary agalactia has a poor prognosis for function in the bitch and queen: a review. Clin
nasal oxytocin spray 10 minutes before lacta- lactation, and neonates should be hand Theriogenol 4:196-205, 2012.
tion q 8h. reared. Failure in milk letdown and galacto-
• Anxious bitches may benefit from mild tran- stasis typically respond to treatment or resolve AUTHOR: Christina Gobello, MV, DVM, DECAR
EDITOR: Michelle A. Kutzler, DVM, PhD, DACT
quilization with phenothiazine compounds spontaneously.
(e.g., acepromazine 0.1-0.25 mg/kg PO
or 0.05-0.1 mg/kg IM or SQ), which also PEARLS & CONSIDERATIONS
increases prolactin release.
• In cases of galactostasis, reduction of milk Comments
production can be achieved by the admin- Lactation disorders do not pose a risk for the
istration of cabergoline 5 mcg/kg PO q 24h female’s life, although they may cause consider-
for 5-7 days. Diuretics and analgesics may able neonatal losses.

Lameness

BASIC INFORMATION Clinical Presentation PHYSICAL EXAM FINDINGS
• Complete general physical looking for
Definition HISTORY, CHIEF COMPLAINT evidence of systemic abnormalities (e.g.,
Alteration of gait caused by structural or Thorough history is critical: fever)
functional abnormality in one or more limbs • Abnormal gait or limping observed by • Complete orthopedic and neurologic exams
owner (pp. 1143 and 1146). Orthopedic exam must
Synonyms • Determine which limb is affected. include assessment of
Favoring leg, limping • Difficulty rising ○ Abnormal posture
• Improves or worsens with exercise ○ Joint effusion, warmth
Epidemiology • Holding limb up ○ Bone, joint, or muscle pain
SPECIES, AGE, SEX • Dragging limb or inappropriate placement ○ Muscle atrophy
Dog or cat, any age, either sex (knuckling) ○ Thickening or bony prominences at or
• Shifting limb lameness near joints
RISK FACTORS • Acute or gradual onset ○ Crepitus
Trauma, genetics, obesity, overnutrition during • Progression over time ○ Abnormal range of motion (ROM) in
growth, tick bites, endocrinopathy joints

www.ExpertConsult.com