OTHER DIAGNOSTIC TESTS

Whilst the HPI can provide an overall sense of direction, further indicators are of course needed to shape policy and flesh out the details of societies that can achieve good lives without costing the Earth. With that in mind, researchers are starting to build a coalition of organisations to develop a framework for measuring societal progress (figure 6).

This framework should start by distinguishing between three different spheres: our goals (in terms of well-being for all), our scarcest resources (limited ecological resources), and the processes and systems which should be designed to achieve maximal well-being outputs with minimal resource inputs. Within the latter sphere, researchers have separated out the economic systems as these are the ones that have been the biggest focus of policy to date and are the ones that likely require the biggest change to enable sustainable well-being for all. It is upon the human systems that governments have the most immediate influence, but it is well-being and sustainability that they must ultimately seek to enhance.

For policy-making, in-depth measurement is needed within each of the spheres in the figure. But researchers also suggest the identification of five key headline indicators which provide an overall picture of how they are doing. The numbers within the diagram relate to these headline indicators:

v measure of environmental pressure per capita (for the resources sphere);

v measure of the percentage of the population flourishing (for the goals sphere);

v measure of economic performance – how well the economy is doing in terms of delivering sustainability and well-being for all (for the economic half of the human systems sphere);

v measure or set of measures of the other (non-economic) policy-amenable drivers of wellbeing for all (for the remaining human systems);

v measure of well-being per unit of environmental pressure (the HPI, or an HPI-like measure; connecting the resources and goals spheres).

Researchers propose that this framework is linked together, so that the headline indicators connect to the more detailed ones, providing a more joined-up approach to policy-making which puts the overall goals of society at the heart of political decisions.

THE LIST OF THE USED LITERATURE

1. Edmund Konway – 50 Economics Ideas You Really Need to Know

2. Happiness and Economics: How the Economy and Institutions Affect Human Well-Being

3. Mark Anielski – The Economics of Happiness

4. NEF (the new economics foundation) –The happy planet index: 2012 Report / A global index of sustainable well-being

5. Newspaper “The Sunday Times” – article “Happiness is the new economics”

6. S. Frey and Alois Stutzer – The Economics of Happiness Bruno

7. The economic journal Happiness & Economics; How the Economy and Institutions Affect Human Well-Being (Robert Macculloch)

OTHER DIAGNOSTIC TESTS

One parameter that cannot be determined from the intensity of a heart murmur is the stage of heart disease or failure the animal is in. For instance, severe mitral insufficiency might not be associated with any murmur whatsoever, whereas a loud one might accompany an early case. This is because in the later stages, the valve might become so diseased and worn that it offers so little resistance to blood flow back through it that a murmur-causing disruption of blood flow might not arise.

Radiographs and/or ultrasonography of the chest are essential for establishing a diagnosis of heart disease. Animals with primary lung disease, including pneumonia, can exhibit clinical signs very similar to those seen in patients with heart failure, and these tests are needed to differentiate the two. Diseased hearts will appear abnormally enlarged on both tests. This enlargement can occur in compensation for the heart having to work harder to pump blood, or it could be due to a thinning and bulging of the heart wall resulting from constant bombardment with high-pressure streams of blood escaping through faulty heart valves. Regardless of the cause, an enlarged heart, combined with clinical signs or murmurs, signifies heart disease. If such a combination exists, the next test most practitioners will perform is an electrocardiogram.

The electrocardiogram (ECG; often phonetically pronounced EKG) is a test used widely to assess the condition of the heart. Remember that a heartbeat is produced when a wave of electrical energy moves through the tissues of the chambers, starting in the atria and moving down to the ventricles. This electrical wave then makes the muscle wall of these chambers contract, pumping out the blood contained within.

The ECG helps evaluate the status of this electrical conduction system, and at the same time, can give the veterinarian useful information regarding the size of the heart itself, and indirectly, the condition of the heart as a pump. In addition, with the information gained from an ECG, proper drug treatment dosages can be more easily established.

Treatment

Because most cases of heart disease or failure are nonreversible, the treatment goal for any dog or cat suffering from such a condition is to create an environment that relieves some of the workload on the heart and slows the progression of the disease.

Canines and felines with bad hearts need to be fed special diets that are moderately restricted in sodium to help reduce blood pressure and discourage the accumulation of fluid within the lungs and/or the abdomen. Diets formulated especially for this purpose are available from veterinarians.

Diuretic drugs are also used in heart failure patients to help mobilize and eliminate excessive fluid that might be accumulating within the body. In many instances, this diuretic therapy, combined with a low-sodium diet, might be all that it takes to relieve the coughing and discomfort seen in affected pets. Remember that a dog or cat on diuretic medication will drink lots of water and urinate with greater frequency, so be sure to provide it with plenty of water to drink at all times, and be prepared for plenty of walks outside or frequent trips to the litterbox.

Medications designed to dilate the blood vessels, making it easier for the diseased heart to pump blood through them, are usually the next in line if the special diet and diuretics don’t seem to be enough to correct the problem.

If none of the treatment regimens described above prove effective, the final medicating step often taken to manage the heart failure is to give drugs designed to help slow and strengthen the heart’s contraction. Such medications can have many undesirable and serious side effects if a veterinarian does not carefully monitor therapy, but, on average, they will prolong the life of a pet in heart failure for an average of 4 to 6 months.

Arterial Thromboembolism (Cats)

Cats afflicted with cardiomyopathy suffer from impaired circulation, which in turn can lead to a condition known as arterial thromboembolism. This disorder is characterized by large blood clots that form within the left side of the heart and pass into circulation, only to lodge within one or more blood vessels within the body, usually at the point where the large aorta divides into two smaller arteries that supply the hindlimbs.

When such a clot restricts blood flow to the back legs, pronounced hindlimb weakness results. The hind paws might feel cold to the touch, and the clear nails might take on a bluish hue. As the muscles of the hind end are deprived of blood and oxygen, they become firm and painful to the touch. Diagnosis of arterial thromboembolism is based on clinical signs and physical exam findings. Ultrasound can be used to assess the condition of the heart and to identify thrombi still within the organ. A total absence or partial reduction in hind limb pulse is diagnostic of a thromboembolism as well.

Treatment for arterial thromboembolism is difficult at best. Surgery is usually unrewarding, and the existing heart disease in these cats makes them high anesthesia risks. Medical therapy can be somewhat effective if instituted within a few hours of onset. This involves administering drugs designed to dissolve the blood clot, prevent further thrombi from developing, and restore normal blood flow

Prognosis for a full recovery is guarded, simply because of the preexisting heart disease and because of chronic pain and tissue damage caused by the temporary loss of oxygen. However, with physical therapy and attentive nursing care, many cats experience at least partial functional restoration in 1 or 2 months. Obviously, management of the preexisting cardiomyopathy is necessary as well.

Anemia

Anemia is defined as an overall reduction in the number of red blood cells within the bloodstream relative to normal levels within that pet. This reduction can occur from a number of processes, including an increased destruction or decreased production of red blood cells within the body. The overall consequence of anemia is the inability of the blood to supply desired levels of oxygen to the tissues.

Signs seen in an anemic pet include intense lethargy, weakness, increased respiratory and heart rates, and a pallor of the mucous membranes. Depending upon the cause of the anemia, signs related to a blood clotting disorder might be seen as well. Finally, if red blood cells are being destroyed within the body, the skin and mucous membranes might become jaundiced.

A simple blood test performed by a veterinarian can tell you if your dog or cat is anemic. Treatment of anemia depends on the underlying cause. In severe cases, blood transfusions and oxygen therapy might be required to save the pet’s life until the cause can be identified and treated. Therapy utilizing special compounds called colloids and other oxygen-carrying solutions can be lifesaving as well.

Bleeding Disorders

Whenever an injury or illness compromises a blood vessel and leads to bleeding out of that vessel, a remarkable mechanism or chain reaction begins within the body in an effort to stop the leakage of blood from the damaged vessel and prevent the individual from bleeding to death.

This mechanism is known as hemostasis. When a blood vessel is compromised, the first reaction that occurs is constriction of the vessel to help slow blood loss. Following this, special blood cells called platelets begin to adhere to the injured vessel wall, forming a temporary plug. At the same time, a coagulation (clotting) pathway is activated within the body, involving a complex interaction of blood and tissue components, as well as calcium and vitamin K. The end result of this pathway is the formation of a more permanent clot at the site of injury.

Bleeding disorders can occur whenever any part of the clotting mechanism is interfered with. Diseases or substances such as toxins, drugs, cancers, autoimmune hemolytic anemia, and infectious agents, such as Ehrlichia canis, can interfere with platelet numbers or function. In addition, kidney disease and certain inherited defects can also lead to poor platelet function and secondary bleeding.

Any disruptions of the coagulation pathway also spell trouble for hemostasis. For instance, most rodent poisons contain substances that interfere with the vitamin K component of the coagulation pathway. If a dog or cat accidentally ingests these, its coagulation pathway will be effectively disrupted. Also, inherited defects in the coagulation pathway can cause bleeding disorders known as hemophilia and von Willebrand’s disease.

Serious diseases or injuries such as heartworm disease, viral diseases, and massive trauma (such as that caused by a car) can lead to a secondary condition known as disseminated intravascular coagulation (DIC). In DIC, tiny blood clots form throughout the body. Not only are these clots detrimental to the health of the animal, but DIC also leads to a depletion of the body’s clotting components. This, in turn, predisposes the pet to a bleeding disorder. DIC is invariably fatal to a pet unless rapid supportive treatment is instituted.

Clinical signs of a bleeding disorder usually include noticeable bruising of the skin and mucous membranes. Blood in the urine or feces, nosebleeds, joint pain, abdominal pain, and breathing difficulties might be seen as well. Because of the variety of potential causes, a veterinarian will need to run a series of tests to determine the exact cause and to formulate a proper treatment regimen. Initial treatment for any bleeding disorder entails blood transfusions until the exact cause is discerned. If rodenticide poisoning is suspected, vitamin K injections, followed by oral vitamin K tablets, will help reverse the effects of certain rodenticides. These tablets should be given daily for a minimum of 4 weeks, since the ingested poison could linger within the body and exert its effects for this length of time.

Finally, for autoimmune clotting defects, steroid therapy can be used to help control the disease and subsequent bleeding.

Date: 2014-12-21; view: 1158