Friday, October 31, 2008

Happy Halloween!

We are having a pet costume contest at the hospital today. It has been lots of fun to see how creative our clients are and how darned patient those poor critters are. Don't you wonder what is going through their minds when their humans start stuffing them into those pink ruffled tutus or black shiny bumble bee outfits? One year I glued pom-poms all over Verbal (my lab/golden cross), painted her toenails pink and gave her a rhinestone collar-the perfect poodle dog. Yes, humans are strange creatures, indeed.

Ricardo, our newly 3-legged kitty, came in yesterday for a recheck exam. He is having a weird reaction to his pain medication; his temperature was over 105 degrees! This has been reported in some cats getting opiate-type pain relievers, so we had taken his transdermal fentanyl patch off right after his surgery and started him on a different medication, buprenex. I guess it wasn't the right choice for him, either. He is on an NSAID and a good antibiotic, the incision itself looks clean, dry, no redness or swelling or discharge to indicate infection. It must be this rare opiod reaction. We will try a low dose of still a different med, tramadol. I don't use it often in cats because I sometimes see them act a little "wiggy" on it, confused, ataxic (wobbly), vocalizing, (crying), but we are running out of choices for Ricardo and he has to have SOMETHING for pain relief. He had a leg cut off for Pete's sake. He is eating and drinking and using his litter box just fine...what a trooper. Sure wish humans could be as resilient as animals.
Well, I have officially blogged for a whole work week now. Thank you for sticking with me so far and for the helpful comments. Please keep them coming. If you have any questions, we can do an "ask the vet" type of column on certain days. E-mail me at Contact DrReneigh

If I don't know the answer, I'll try to do some research and get one for you. Often the answer will be "get your pet to a vet," but we can use this site for general info and helpful hints.
Have a happy and safe Halloween.


Thursday, October 30, 2008

Cancer sucks.

Cancer sucks. How profound is that? I just get so wiped out some days with that horrible diagnosis. A pet comes in for a "simple" limp and I have to give this life and death news. Why does it seem to happen to the nicest pets with the sweetest humans? Some people think cancer is on the rise. It sure could be. Maybe we are better at making the diagnoses, better tests and all. People allow us to do more diagnostically for their critters, too, including advanced imaging like MRIs. I know pets are living longer than they used to, what with better nutrition, better medical care and more pets living cushier lives indoors with their humans. Older animals get more cancers, for sure.

But Chloe is only 6 years old! Talk about a nice dog with a sweet, loving family. She is a wonderful Saint Bernard, full of life and happy to see everyone she meets. Her owners noticed she was limping on a front leg a few weeks ago and didn't think much of it. Then all of a sudden the carpus (wrist) area started to swell up like a balloon and they decided to bring her in to see me. My heart just sank; a giant breed dog (Chloe is around 140 pounds) with a swelling of a long bone almost always equals cancer. I prayed I was wrong. The swelling wasn't particularly warm to the touch, there were no obvious wounds or punctures and it was fluctuant (soft.) Chloe didn't cry when I palpated it, but did lick my hands to let me know she didn't like me messing with it. Radiographs (x-rays) of the swollen area would help us with our diagnosis.

Chloe's owner was particularly concerned about her anxiety during the exam. She seemed to settle down a bit in the examination room but he thought lifting her up to the x-ray table would set her off again. Fortunately, my x-ray machine is a small, portable unit (I used to be a mobile equine (horse) vet exclusively) so we were able to bring it to her and radiograph her leg right there on the floor of the exam room. My technician and assistant put on lead aprons to shield themselves from radiation, then had the owner briefly step out of the room. It only took a few minutes to get the needed images.

Osteosarcoma (primary bone cancer) has a very typical appearance on radiographs. There is an area of lytic bone. (It looks like it has been eaten away.) Sometimes there is a "sunburst" pattern, bright areas of new tumorous bone growth. There can also be small pathologic fractures at the site since the bone is so weak in this area. There are certain bones and certain sites where it is predisposed (most common.) Chloe's lesion was on the distal radius and ulna. This type of cancer does not like to cross the joint, so adjacent bones are not involved as would be the case for things like bone or joint infections. Chloe's adjacent carpal bones were fine. We are sending the radiographs to a radiologist for review as we do all of our films, but the diagnosis is fairly certain. So tragic.

Osteosarcoma is a painful disease. Most dogs are euthanized because of this pain very soon after the diagnosis is made unless we can find a way to control it. Amputation is an excellent choice for our patients because they usually have 3 other good legs on which to get around. Chloe doesn't. She has some pretty bad knees and hips, so those back legs couldn't support the additional weight if we were to amputate a front leg. It is possible to use radiation for palliation (pain control.) This requires general anesthesia and is very expensive. Remember I told you about my own dog, Verbal, having radiation for her cancer 2 years ago? It was about $4,000 at that time. Palliative treatments aren't as intensive (don't require as many treatments) so wouldn't likely be quite as expensive, but could be in that general ballpark. I don't know if Chloe's family will choose this for her or not. For now we have Chloe on some really good NSAIDs (non-steroidal anti-inflammatory) meds as well as an opiate drug. There are other drugs we can add as needed to control her pain if her owners think she needs them.

Usually by the time we see a swollen bone with osteosarcoma, we can assume it has metastasized (spread) to the lungs. If the pain of the primary bone lesion doesn't do her in, the coughing/respiratory problems from the lung pathology will. It is a horrible, horrible disease and one I wouldn't wish on anyone. I feel so badly for Chloe's wonderful owners. I have a nice little booklet for them to use to help their children deal with the upcoming loss and grieving that will result when it is time to say goodbye. Times like this I really feel helpless for the owners, but I know I'll at least be able to help alleviate her suffering when that time comes, a choice we don't really have as humans. Cancer, indeed, just sucks.


Wednesday, October 29, 2008

Flake's Angel Fund

Ok, It is no secret by now that I love animals. Sadly, not all pets are as loved and cared for as the ones lucky enough to be brought in for regular veterinary care (like little Ricardo, who is doing great today!)

Unwanted and stray animals often come our way, and if possible, they are rarely turned away for emergency medical care. Then there are those owned by humans just down on their luck, hit by this crummy economy.
In July 2002, when I opened my hospital, Flake's Angel Fund was established by my sister, Teresa, in memory of my beloved first cat, Flake. Flake was with me throughout vet school and beyond, but died of cancer (having fought it for 4 years!) just before the hospital opened. Teresa wanted to set up the fund to help treat the animals that otherwise wouldn't get care. It also supports the non-kill shelters in the area, and became national when it donated more than $500 in cash and supplies to the animal victims of hurricane Katrina.

So far, the fund has helped patch up and find homes for well over 100 animals, including dogs, cats, rabbits, even rats and a lizard. Many were adopted by staff members of the hospital.
Last week a very nice client came in with her newly adopted dog from the shelter. Lucy was very sick, hanging her head, depressed, dehydrated, wouldn't eat and had been vomitting and had diarrhea. Due to her recent exposure to other shelter dogs and her unknown vaccine status, I suspected (and confirmed with a fecal test) parvo virus enteritis, a potentially deadly disease of the gastointestinal tract. There is a new strain of parvo out right now that also affects the heart, so I was quite worried for Lucy.

Now this owner had done everything right. She didn't adopt from a pet store or a puppy mill breeder. She gave a homeless dog a chance, had her spayed and vaccinated and dewormed. But she had just spent a lot of money on a procedure for her other beloved dog the month before and here she was faced with the potential for a huge vet bill on a dog she just got 3 days earlier. We have good luck treating parvo IF we are able to. Some of the sick puppies might be hospitalized for a week or more on IV fluids, injectable meds to control vomitting and infection, intensive care, and isolation from other animals. (It would be a disaster if hospital staff passed on the disease to the vulnerable, sick animals here for other reasons.) Other parvo dogs might just need some subcutaneous (under the skin) fluids and antiemetics (antivomitting) meds and a short hospital stay. It really is impossible to know how a dog will do before you start treating, so we have to give a wide range of an estimate for care. It was just too much for this poor client to handle. She elected to euthanize Lucy, knowing she couldn't continue as she was without any treatment.

Enter Flake's fund. We asked the client if she would be willing to transfer her ownership over to the hospital and allow us to try and treat Lucy, knowing she could very well die anyway, but at least give her a chance. The owner seemed very grateful that we would do this for her, and even contributed the costs of what she would have spent to euthanize her anyway.

Lucy was a fighter and very lucky. She obviously didn't have the virulent new strain of parvo, stopped her vomitting and diarrhea and was eating her bland food ravenously by the 2nd day. Ordinarily we try to find a new home for these Flake's Fund critters, but we knew that this client was a good one and had just fallen on some hard times. Hoping these are just temporary, we decided to adopt Lucy back to the original owner. Boy, did that feel good! Unfortunately, we can't do this for every pet that comes in. We have a business to run and I have 7 employees that I am responsible for. But once in awhile special cases touch our hearts just right. I think Flake would have approved.


Tuesday, October 28, 2008

3 legged Cat

I had to amputate a front leg on a really sweet, really scared cat today. As horrible as that sounds, Ricardo was actually very lucky. After being hit by a car or caught in a fence or whatever trauma caused his elbow to become dislocated, he actually made it home after 5 days missing. His owner had been frantic, so when he turned up with a useless front leg, she rushed him in to us. Of course her first concern was that he wouldn't be hurting anymore. She said he was essentially a feral (wild) cat, and couldn't be handled without sedation at the last visit to a vet's. Either due to the fear or pain or weakness, he has been just fine for us, but we did get some pretty good pain meds in him right away.

You might be wondering why we amputated a leg with a simple dislocated elbow. We tried to pop the elbow back into place today and it went in really easily....thus the problem. It slid back and forth WAY too easily and just wouldn't stay reduced (fixed.) Splints or casts just don't work for something like this, so open reduction (surgery) was required. The cost for a board certified veterinary surgeon to fix the elbow was too much for Ricardo's mom at this time, and there is more chance of complications, costly follow up care, etc., so amputation, while far from ideal, is an acceptable choice. He got a nice narcotic pain patch placed on him for a constant supply of pain relief meds, and will get some others as he needs them. He is all bundled up in a nice heated kennel right now, pretty zoned out. Just the way I'd want to be if it were me waking up from something like that. Like I said, Ricardo is a lucky cat to have come home at all- and to have an owner who was able to do this for him.


Monday, October 27, 2008

My Pets Live With a Vet

Hello friends. I rarely even read blogs much less write on ones, so this will likely be very sparse at first. I am a veterinarian, and have often used the title statement when talking to some of my "scardey-cat" patients in the exam room. They may be hiding under the bench or behind their owner's legs, and I let them know how much worse it could critters get to live with a veterinarian 24 hours a day, their entire lives! Such is their lot in life.

Since I'm new to this whole blogging thing, I'll have to look around the site a bit and see what goes on here. My idea was to write about the characters, animals and human, that I see on a daily basis. I love being a vet, but it is a challenging, very emotional job at times. It's no secret that the economy sucks right now, and many of my clients are hurting. We are seeing more people waiting out an illness or injury, hoping it will get better on its own before making an appointment to bring their friend in. Silly, really, because often those problems become much worse with time and will end up costing MORE to fix, if it isn't too late to fix at all. That is becoming a more common issue, too....people facing the choice of expensive treatment plans vs. euthanasia for a beloved pet simply because of the cost. Such a shame. I live in the real world, too, so I certainly understand this. My husband and I had tough choices to make 2 years ago when our own dog, Verbal, had cancer. She required radiation treatments that were over $4,000! We were struggling with our own money issues, having this veterinary hospital to run with many employees' livelihoods on the line. Somehow we made it work and she is cancer-free today, thank God. No vacations for us for awhile, though.

So, I'll drop in when I can and jot down notes about interesting cases or personalities we come across in the course of practicing the art of veterinary medicine. Any suggestions for making a more readable or interesting blog are welcome.