OVA. There were five promotional CGI-only Original video animation episodes released, [citation needed] the first four were sold with the initial Dinozone toys in Japan.Genetic Testing - Medical Clinical Policy Bulletins. Number: 0. 14. 0Policy. Aetna considers genetic testing medically necessary to establish a molecular diagnosis of an inheritable disease when all of the following are met: The member displays clinical features, or is at direct risk of inheriting the mutation in question (pre- symptomatic); and. The result of the test will directly impact the treatment being delivered to the member; and. ![]() After history, physical examination, pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, a definitive diagnosis remains uncertain, and one of the following diagnoses is suspected (this list is not all- inclusive): Achondroplasia (FGFR3)Albinism. Alpha- 1 antitrypsin deficiency (SERPINA1)Alpha thalassemia/Hb Bart hydrops fetalis syndrome/Hb. H disease** (HBA1/HBA2, alpha globin 1 and alpha globulin 2)Angelman syndrome (GABRA, SNRPNBardet- Biedl syndrome. Beta thalassemia** (beta globin)Bloom syndrome (BLM)CADASIL (see below)Canavan disease (ASPA (aspartoacylase A))Charcot- Marie Tooth disease (PMP- 2. Classical lissencephaly. Congenital adrenal hyperplasia/2. ![]() CYP2. 1A2)*Congenital amegakaryocytic thrombocytopenia. Congenital central hypoventilation syndrome (PHOX2. B)Congenital muscular dystrophytype 1. C (MDC1. C) (FKRP (Fukutin related protein))Crouzon syndrome (FGFR2, FGFR3)Cystic fibrosis (CFTR) (see below)Dentatorubral- pallidoluysian atrophy. The crust of the Earth is composed of a great variety of igneous, metamorphic, and sedimentary rocks. The crust is underlain by the mantle. The upper part of the. Cannabinoid-based (CBD) products are a godsend to pet parents looking to treat their pets. Duchenne/Becker muscular dystrophy (dystrophin)Dysferlin myopathy. Ehlers- Danlos syndrome. ![]() Emery- Dreifuss muscular dystrophy (EDMD1, 2, and 3)Fabry disease. Factor V Leiden mutation (F5 (Factor V))Factor XIII deficiency, congenital (F1. Factor XIII beta globulin))Familial adenomatous polyposis coli (APC) (see below)Familial dysautonomia (IKBKAP) Familial hypocalciuric hypercalcemia (see below)Familial Mediterranean fever (MEFV)Fanconi anemia (FANCC, FANCD)Fragile X syndrome, FRAXA (FMR1) (see below)Friedreich's ataxia (FRDA (frataxin))Galactosemia (GALT)Gaucher disease (GBA (acid beta glucosidase))Gitelman's syndrome. Hemoglobin E thalassemia **Hemoglobin S and/or C **Hemophilia A/VWF (F8 ( Factor VIII))Hemophilia B (F9 (Factor IX))Hereditary amyloidosis (TTR variants)Hereditary deafness (GJB2 (Connexin- 2. Connexin- 3. 2 ))Hereditary hemorrhagic telangiectasia (HHT)Hereditary hemochromatosis (HFE) (see below)Hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome (fumarate hydratase (FH) gene)Hereditary neuropathy with liability to pressure palsies (HNPP)Hereditary non- polyposis colorectal cancer (HNPCC) (MLH1, MSH2, MSH6. MSI) ( see below)Hereditary pancreatitis (PRSS1) (see below)Hereditary paraganglioma (SDHD, SDHB)Hereditary polyposis coli (APC)Hereditary spastic paraplegia 3 (SPG3. A) and 4 (SPG4, SPAST) Huntington's disease (HTT, HD (Huntington))Hypochondroplasia (FGFR3)Hypertrophic cardiomyopathy (see below)Jackson- Weiss syndrome (FGFR2)Joubert syndrome. Kallmann syndrome (FGFR1)Kennedy disease (SBMA)Leber hereditary optic neuropathy (LHON) Leigh Syndrome and NARP (neurogenic muscle weakness, ataxia, and retinitis pigmentosa) Long QT syndrome (see below)Limb girdle muscular dystrophy (LGMD1, LGMD2) (FKRP (Fukutin related protein))Malignant hyperthermia (RYR1)Maple syrup urine disease (branched- chain keto acid dehydrogenase E1)Marfan’s syndrome (TGFBR1, TGFBR2)Mc. Ardle's disease. Medium chain acyl co. A dehydrogenase deficiency (ACADM)Medullary thyroid carcinoma. MELAS (mitochondrial encephalomyopathy with lactic acidosis and stroke- like episodes) (MTTL1, t. RNAleu)Meckel- Gruber syndrome. Mucolipidosis type IV (MCOLN1, mucolipin 1)Mucopolysaccharidoses type 1 (MPS- 1)Muenke syndrome (FGFR3)Multiple endocrine neoplasia type 1. Muscle- Eye- Brain disease (POMGNT1)MYH- associated polyposis (MYH) (see below)Myoclonic epilepsy (MERRF) (MTTK (t. RNAlys))Myotonic dystrophy (DMPK, ZNF- 9)Neimann- Pick disease, type A (SMPD1, sphingomyelin phosphodiesterase)Nephrotic syndrome, congenital (NPHS1, NPHS2)Neurofibromatosis type 1 (NF1, neurofibromin)Neurofibromatosis type 2 (Merlin)Neutropenia, congenital cyclic. Nephronophthisis. Phenylketonuria (PAH)Pfeiffer syndrome (FGFR1)Prader- Willi- Angelman syndrome (SNRPN, GABRA5, NIPA1, UBE3. A, ANCR, GABRA )Primary dystonia (TOR1. A (DYT1))Prothrombin (F2 (Factor II, 2. G> A mutation))Pyruvate kinase deficiency (PKD)Retinoblastoma (Rh)Rett syndrome (FOXG1, MECP2)Saethre- Chotzen syndrome (TWIST, FGFR2)SHOX- related short stature (see below)Smith- Lemli- Opitz syndrome. Spinal muscular atrophy (SMN1, SMN2)Spinocerebellar ataxia (SCA types 1, 2, 3 (MJD), 6 (CACNA1. A), 7, 8, 1. 0, 1. DRPLA) Tay- Sachs disease (HEXA (hexosaminidase A))Thanatophoric dysplasia (FGFR3)Von Gierke disease (G6. PC, Glycogen storage disease, Type 1a)Von Hippel- Lindau syndrome (VHL)Walker- Warburg syndrome (POMGNT1)2. DCGR (CATCH- 2. 2))* Medically necessary if results of the adrenocortical profile following cosyntropin stimulation test are equivocal or for purposes of genetic counseling.** Electrophoresis is the appropriate initial laboratory test for individuals judged to be at- risk for a hemoglobin disorder. In the absence of specific information regarding advances in the knowledge of mutation characteristics for a particular disorder, the current literature indicates that genetic tests for inherited disease need only be conducted once per lifetime of the member. Note: Genetic testing of Aetna members is excluded from coverage under Aetna's benefit plans if the testing is performed primarily for the medical management of other family members who are not covered under an Aetna benefit plan. In these circumstances, the insurance carrier for the family members who are not covered by Aetna should be contacted regarding coverage of genetic testing. Occasionally, genetic testing of tissue samples from other family members who are not covered by Aetna may be required to provide the medical information necessary for the proper medical care of an Aetna member. Aetna covers genetic testing for heritable disorders in non- Aetna members when all of the following conditions are met: The information is needed to adequately assess risk in the Aetna member; and. The information will be used in the immediate care plan of the Aetna member; and. The non- Aetna member's benefit plan, if any, will not cover the test (a copy of the denial letter*** from the non- Aetna member's benefit plan must be provided).*** Aetna may also request a copy of the certificate of coverage from the non- member's health insurance plan if: (i) the denial letter from the non- member's insurance carrier fails to specify the basis for non- coverage; (ii) the denial is based on a specific plan exclusion; or (iii) the genetic test is denied by the non- member's insurance carrier as not medically necessary and the medical information provided to Aetna does not make clear why testing would not be of significant medical benefit to the non- member. Medical Necessity Criteria for Specific Genetic Tests: Adenosis polyposis coli (APC): Aetna considers adenosis polyposis coli (APC) genetic testing medically necessary for either of the following indications: Members with greater than 1. Members with a desmoid tumor, hepatoblastoma, or cribriform- morular variant of papillary thyroid cancer; or. Members with 1st- degree relatives (i. FAP) or with a documented APC mutation. The specific APC mutation should be identified in the affected 1st- degree relative with FAP prior to testing the member, if feasible. Full sequence APC genetic testing is considered medically necessary only when it is not possible to determine the family mutation first. Aetna considers APC genetic testing experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established. CADASIL: Aetna considers DNA testing for CADASIL medically necessary for either of the following indications: Pre- symptomatic individuals where there is a family history consistent with an autosomal dominant pattern of inheritance and there is a known mutation in an affected member of the family; or. Symptomatic individuals who have a family history consistent with an autosomal dominant pattern of inheritance of this condition (clinical signs and symptoms of CADASIL include stroke, cognitive defects and/or dementia, migraine, and psychiatric disturbances). Head Tremors In the Bulldog. Information and survey results below.© COPYRIGHT 2. Permission must be granted for publication in whole or part. Head Tremors In the Bulldog- Partial/ Focal Seizures, Paroxysmal Dyskinesia. By Kathy Jacobsen. The topic of this article, very simply put is: head tremors, fly biting and circling behaviors in our beloved Bullies. Looking at the title, however, it becomes painfully apparent that these neurological anomalies that we are seeing in the bulldog today fall into the "gray" area of veterinary and human neurological disorders. What qualifies me to discuss such a topic, you might ask? My answer to you would be good old experience. I have been in bulldogs for close to 1. I plan on reviewing the scientific findings from articles I have pulled from the internet and then share my experience, including what I did to minimize the behaviors along with how well it worked on each dog. Let's start with some general definitions taken directly from the literature: Epilepsy: "a chronic condition characterized by recurrent seizures. It is a disorder of the brain where abnormal electrical activity triggers further uncoordinated nerve transmission. This uncoordinated and haphazard nerve tissue activity scrambles messages to the muscles or your dog's body and the coordinated use of muscles is then inhibited." The characteristic seizure activity seen in epilepsy are classed as- Seizures: involuntary contraction of muscles, caused by an electrical storm in the brain that can be everywhere at once and can be seen on EEG. Partial seizure where the abnormal electrical impulses begin in a small area of the brain and may or may not migrate to other areas of the brain. Focal/Partial seizures. Simple focal seizures (minor motor or focal motor seizures) when consciousness is preserved. The area of the brain that is affected is the area that controls movement. Usually the face is affected, resulting in twitching or blinking. This is usually limited to one side of the face. The dog is usually alert and aware of it's surroundings. Complex focal seizures when consciousness is altered ie the pet is staring off into the distance but you cannot gain their attention. This seizure will originate in the area of the brain that controls behavior and is sometimes called a psychomotor seizure. The dog's consciousness will be altered and he may exhibit bizarre behavior such as unprovoked aggression or extreme irrational fear. He may run uncontrollably, engage in senseless, repetitive behavior or have fly- snapping episodes where he appears to be biting at imaginary flies around his head. Grand Mal (tonic- clonic) seizures which begins with an involuntary contraction of all skeletal muscles and loss of consciousness. Paroxysmal Dyskinesia is a movement disorder. There are brief attacks of the symptoms with the dog appearing perfectly normal between the episodes; the same way there are discrete attacks of seizures in epilepsy. Dyskinesia refers to an abnormal, involuntary movement or posture. Movement disorders usually originate from the deeper areas (the basal nuclei) of the brain. These areas are responsible for translating the commands from higher brain areas (e. The distinction in the human between seizure activity and dyskinesias is based on looking for abnormal electrical activity on the surface of the brain with an EEG. By definition, seizures have abnormal EEG activity, while paroxysmal dyskinesias do not. People with paroxysmal dyskineasis often experience a decrease in episodes as they age while epileptic people and dogs will worsen with age. Let's talk now about Head Tremors in the Bulldog. In my experience, head tremor activity in the Bulldog usually starts around the age of 2 years old. The motion you will see will almost always be a fast side to side rocking motion (ear to shoulder ear to shoulder) occurring in rapid succession. Occasionally I have seen an up and down motion (like they are shaking their heads to say yes) but for the most part it is the same fast rocking. The way it was defined to me was that the neuron cluster that controls a certain motor function, in this case head movement, begins to fire continuously. The reason for this rapid fire is truly unknown. I have not experienced any drooling or other body part involvement. It has always been isolated to the head. When you call the dog's name they can stop the bobbing motion for a few seconds and will look at you, then it will kick in again. They can move their heads and watch you move from place to place, they can even walk around etc. Scenario I: The bully will be sleeping very soundly and all of a sudden the head will start rocking usually from side to side very quickly- occasionally you might experience one bobbing up and down. This sudden head motion will cause the bully to awaken suddenly. An episode will last from 1. It may stop on its own and then as the dog lies down to go back to sleep the head tremor will reoccur. Scenario II: A bitch will be pre- season or just come into season. Males head is bobbing for all it is worth. Scenario III: A bitch is post whelp, in the milk let down phase of lactation, and trying to nurse a litter of hungry pups. In this case the bitch has had surgical trauma as the result of a C section, is in pain, is not eating and is trying to make milk. This, in my opinion is different than the head tremors described in Scenario I and II. When you see this What Do You Do? The first time we experienced this phenomena was a scenario III post whelp I panicked. I grabbed the puppies off the bitch and almost caused one to aspirate. When I gained a little composure I called a breeder friend of mine and explained what I was seeing. She told me that it was not uncommon and I should try to get some sugar, honey, Karo syrup into her. The thought is that the blood sugar had experienced a sharp drop at that point in time thus stimulating this type of a response. We gave the girl the Karo and low and behold the tremors stopped within a couple of seconds. The next time we witnessed this behavior was a little different. The bitch was not post whelp. However, she was 3 days prior to coming into season. She had been sleeping on the couch. We gave her honey. It stopped. Started up 1. Same result. We gave her frozen yogurt, same result. This went on for almost 2. Needless to say we packed her up and went off to the vet who said: this is not unusual in this breed. Normally we don't do anything. Epilepsy meds have proven to be ineffective for the most part; phenobarb has too many side effects. The Veterinarian stated that they suspect it has something to do with the growth activity at this age or stress, which can cause a sudden drop in glucose levels in the blood. There can be different things or circumstances that can trigger an episode. Such as a traumatic experience, and injury, hormones, etc. In this girls case we have determined that it is a hormone trigger, specifically at the time of a progesterone spike associated with ovulation. The vet recommended Calcium and Taurine supplementation twice daily. As you know calcium is one of the minerals needed for healthy nerve growth and electrical conductivity, Taurine is an amino acid that works with Calcium. The Vet said she might grow out of it. So, we took that information and we asked for a referral to a neurologist. This specialist did all of the neurological tests and determined she was fine. She ordered ionized calcium levels along with several other specific blood tests. The results all came back normal. She recommended an MRI to determine if there was an injury or tumor. We declined this step at the time, due to finances but decided if she showed any other neurological symptoms such as falling down or aggression, which could be indicative of an injury or tumor, that we would come back to do the MRI. Six months went by on the Calcium, Taurine supplementation to which we added a heaping tablespoon of Ricotta cheese every morning and every couple of days a heaping bowl of frozen vanilla yogurt with honey in the evening. No incidents. The day we bred her in at the time of the progesterone spike indicating ovulation that we were waiting for she had one mild episode then nothing for the entire pregnancy. The episodes started up the second week of lactation when the calcium bolus given at the time of the C- section was gone and 6 hungry puppies were pulling on her calcium/glucose levels. Five months have since passed and she has been just fine no episodes.
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