Page 262 - WSAVA2018
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 25-28 September, 2018 | Singapore
product currently available adequately replaces all
of the functions served by tears. As such, application
of tear supplements can have a dilutional effect on those tears being naturally produced. In addition, any product (and especially the preservatives most contain) can cause surface irritation. Finally, tear supplement solutions may require extremely frequent application to be effective. These factors have made this a problematic area in veterinary medicine. Commercial introduction of hyaluronan tear replacement products has provided an important adjunctive therapy for most dogs with KCS. These products have mucinomimetic properties and some are available in a preservative-free formulation. They are extremely well tolerated in dogs and cats. I typically use hyaluronans early in the treatment schedule while CsA is being introduced but often continue them even if adequate tear production returns.
Secondary infection
Secondary infection is common when tear quality
or quantity declines. This is best treated with a well- tolerated, reasonably broad-spectrum antibiotic with
the major goal being control of normal Gram-positive flora overgrowth. Triple antibiotic (neomycin-polymyxin- bacitracin) ophthalmic ointment is an excellent choice. This can be discontinued as soon as STT values improve and mucopurulent discharge declines since chronic topical antibiotic therapy is contraindicated for maximal ocular surface health.
Parotid duct transposition
It is my opinion that parotid duct transposition (PDT)
is associated with significant complications in some patients and does not obviate the need for ongoing medical management. Therefore, medical management is the preferred method of treatment and should always be attempted first. I reserve PDT for those cases in which a thorough clinical examination has failed to reveal a cause and which have not responded to protracted
and multiple medical therapies – typically patients with congenital glandular aplasia/hypoplasia.
J. Van Dyke1
1CRI, Faculty, Wellington, USA
Diplomate American College of Veterinary Sports Medicine and Rehabilitation
Wellington, Florida USA
Therapeutic plans in veterinary rehabilitation generally involve a combination of manual therapies (joint mobilizations and soft tissue mobilizations), physical modalities (laser, therapeutic ultrasound, e-stim, shockwave), and therapeutic exercises. The modalities are generally used to prepare the tissues for the manual therapies and therapeutic exercises. Physical modalities should never be the sole therapeutic method applied
to any patient.Therapeutic parameters for each modality are chosen based upon the acuity of the injury, so the therapist must be well versed on the definitions of
the acute, subacute, and chronic phases of healing. The mechanism of action for neuromuscular electrical stimulation (NMES) is electrical stimulation causing muscle contraction. The mechanism of action for transcutaneous electrical nerve stimulation is electrical stimulation at a frequency that does not cause muscle contraction but that blocks afferent input leading to pain relief.
NMES has many applications in veterinary rehabilitation including reduction of edema, muscle reeducation, reversal of atrophy, and wound healing. At the cellular level, NMES causes excitation of nerve cells leading
to changes in cell membrane permeability, stimulation of protein synthesis and stimulation of fibroblast and osteoblast activity. Wound healing is enhanced through increased blood flow to the area and stimulated cell turnover.TENS is used for pain control. In very simplistic terms, TENS works along the lines of the Gate Theory introduced by Wall and Melczak in the 1960’s: the severity of pain sensation is a result of the balance between the excitatory and inhibitory inputs to the T cells in the spinal cord. By stimulating peripheral nerves at proper frequencies, the excitatory nociceptive inputs can be blocked from traveling to the brain where pain is recognized. TENS has a short-lived effect, lasting perhaps up to an hour after the application is stopped. It is used in veterinary rehabilitation as immediate

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