Wednesday, December 31, 2008

Happy New Year!



Charlie started limping on his left hind leg about two months ago. Then he got better. Then he chased after a cat and the lameness returned. It seemed to get better with rest, so his owner wasn't too worried. And then yesterday he started limping again-what a bummer! Charlie's owner now realized her big guy would need some help with this problem.

When I see a dog with a hind limb lameness, especially in a large breed dog like Charlie, I expect the lameness to be in the stifle (knee) until proven otherwise. Literally 80% of these limping dogs have injured a structure in their stifles called a cranial cruciate ligament, and if it is an intermittent or on-again, off-again lameness as Charlie was showing, that percentage is even higher. Initially, the injury causes pain and thus the first signs of lameness are seen. Then when swelling occurs because of the trauma to the tissues and subsequent inflammation, the joint becomes tight and falsely stabilized, resulting in a more normal gait. With rest and/or anti-inflammatory medication, swelling can be reduced and the joint becomes "loose" again, there is bone to bone contact with arthritis developing quickly and, you guessed it, the lameness returns. It is a very predictable pattern and helps us diagnose this very common condition.

The stifle has some pretty complex anatomy. The cruciate ligaments (there are two of them, the cranial and caudal) cross each other in the center of the joint, keeping the joint from moving in an abnormal way. The cranial cruciate prevents the lower bone, the tibia, from moving forward out from under the upper bone called the femur. The action that damages this ligament most commonly is jumping and landing on it while simultaneously twisting to turn in another direction. My own dog, Verbal, ruptured her cruciate ligaments when she was playing frisbee. Trauma certainly plays a part in this condition, but many of the dogs affected are genetically predisposed due to their conformation-it is usually the dogs that are "upright" in their stifles that are prone to this injury. Their legs look straighter rather than angled when you look at them from the side.

Charlie is a pretty big dog (he is a Golden Retriever) with powerful muscles in his hind legs. Because of this, we needed to sedate him to manipulate his stifle to confirm the diagnosis as well as to take some radiographs of the affected limb. We gave him an injection that combined the sedative with a good pain reliever-this resulted in us being able to do a much more thorough and complete exam. Starting at the toenails (you bet that a broken toenail could cause enough pain to cause limping) and moving on up the limb, we found that Charlie had a chunk of something stuck in the hair between his foot pads. We clipped it out-there wasn't any sore adjacent to this "stuff" so I doubted this was the source of his pain. When I am palpating limbs for sources of pain, I usually compare the lame leg to the opposite normal leg. Charlie's left stifle was noticeably bigger than his right one, and there was some heat and swelling associated with the joint. It was also positive for the "drawer sign"-a test of abnormal motion that is present when cruciate ligaments are no longer stabilizing the joint. There is a graphic of this on the Veterinary Partner website to get a better idea:

Drawer Sign

Charlie's hips seemed fine. We took some radiographs to be sure there weren't any other problems in the stifle, (arthritis can develop quickly in these unstable joints) as well as a view of the hips to rule out hip dysplasia as another cause of pain. The radiologist will review Charlie's films, but they look pretty good to me. We gave Charlie a second injection, a reversal agent to wake him up from the sedative so he could go home right away. The pain relief medication would not be reversed, however-pretty cool, huh? He went home with some oral antiinflammatory and pain relief medications as well as a joint support supplement. We also discussed the importance of starting Charlie on a weight loss diet for his overall joint health as he ages but especially as he recovers from this injury.

Unfortunately, Charlie is facing surgery for repair of his damaged ligaments. His owner found out that rest only got them so far and then the lameness returned-this cycle will continue and will become even worse as degenerative joint disease sets in from the abnormal joint motion. If he were a smaller dog, less than 50 pounds or so, I could repair the stifle with an extracapsular procedure. This tightens up the joint to prevent the drawer motion using very strong suture material placed along the side of the stifle. In these larger dogs, however, a TPLO or Tibial Plateau Leveling Osteotomy is performed. This procedure, utilizing biomechanics of the knee joint, actually alters the angle of the joint, allowing the natural weight-bearing of the dog to stabilize the stifle. As it sounds, a TPLO is a complex, specialized surgery that requires special training and equipment. It is usually done by board certified veterinary surgeons and can be fairly expensive.

Charlie will be looking at rest and rehabilitation for a good 6 to 8 weeks after surgery. He really shouldn't be allowed to run or jump or even climb stairs at first. Passive range of motion exercises may help, and if there is an underwater treadmill available, that would be the best exercise of all to help build up muscles without stressing the joint or the osteotomy repair site. And then there is the very real possibility that he will have to go through all of this all over again if he ruptures the ligaments in the opposite leg.

Happy New Year everyone. We are closing the hospital early today so the staff can get started on their New Years' celebrations. I've enjoyed starting to blog this year and hope to continue it in 2009. Be sure to let me know if you have any topics you would like me to write about-I want to keep this fresh and interesting but need your help to do that!

Peace and Love,
DrReneigh

Tuesday, December 30, 2008

A Trip to the Salad Bar


One of the interesting things about being a veterinarian is that a lot of people think we should know the answer to any animal-related question regardless of the species. It is quite flattering, actually; I doubt they think that way about their human doctors, as limited as MD's are to the single species they see. Some often-asked questions concern the dietary habits of their pets-why do dogs and cats eat grass? Do they eat grass because they are sick? Do they eat it to make themselves vomit? Is their some kind of vitamin deficiency in their diet? Do they fancy themselves as grazing cows?

Many dogs and cats eat grasses and plants of all kinds-even wild canids (wolves, coyotes) and felids (lions, cougars) are known to do this. It doesn't matter if the plant material has nutritional value or not, the animal does not have to be sick before eating the plant, and they do not necessarily vomit afterward. Since their "natural" diet consists of herbivorous (plant-eating) prey animals, grass would be in the stomachs of their "food," and therefore a regular component of their diet. Some cats actually leave this material behind, enhancing their status as true carnivores. Good quality dog and cat foods are nutritionally complete and balanced-there should be no deficiencies causing the pets to search out plant material. Fibrous grass blades have been known to cleanse the gastrointestinal tract, however, expelling mucus, bile and even worms as they pass through. They can also have a "tickle" effect on the lining of the stomach which can induce vomiting.

It is true that some animals eat grass and subsequently vomit, but there is a difference in how they eat the grass that is interesting to note. Healthy animals just having a snack of grass tend to graze small bites slowly and swallow after thoroughly chewing up the blades. Sick pets will attack the grass, gobbling up large volumes almost frantically and will swallow long, sharp blades intact. These are much more irritating to the gastric (stomach) lining and inevitably induce vomiting. Does the ill animal "know" to do this? Nature certainly takes care of things.

If grass eating becomes a new behavior for your pet, one you have never observed in him or her before, it may be a sign of a problem, but likely is just your critter fancying a trip to the salad bar. They could be hungry or just bored. Some diets don't give the pet enough chewing time. Their veterinarians may recommend adding more fiber to the diets in the form of canned or fresh vegetables, or just feeding a higher fiber content diet to begin with. "Senior" and "light" or diet formulas fall into this category. Many pet stores offer for sale pet-safe grasses for house pets to graze on, especially enticing for cats with the munchies. If your critters are eating grass outside, be sure it is free of all pesticides, herbicides and fertilizers that could be toxic or caustic/irritating to the oral tissues.

OK, How many blogs did you read today that talked all about puking? Leave it to your friendly neighborhood veterinarian for such a yummy topic! Hope I didn't ruin your next trip to the actual salad bar. You've got to have an iron stomach in this profession.

Peace,
DrReneigh

Monday, December 29, 2008

Which Came First, the Chicken or the Egg?


I'm not the only one who is glad to see the thaw occurring in the yard and on the streets today. With all the recent snow, my flock of 26 chickens (and "Viggo", the token rooster) haven't ventured out of their coop for two weeks. No way were they going to walk in that cold white stuff. They have all been squeezed onto the perches that they usually use only at night, huddled together trying to keep warm. They have tons of food-and it keeps disappearing, so I know someone is coming down to munch during the day. And some brave or confused girls are still laying eggs-I'm getting 3 or 4 a day despite the short day length. Chickens thrive on long days, just like me. On big egg production farms, hens are kept under lights to artificially stimulate the pituitary gland through the eye. This causes the secretion of a hormone to stimulate the ovary to produce eggs. 15 to 16 hours is an ideal "day" length for laying hens, although in some big production barns, lights are kept on even longer (and is why chickens there tend to "burn out" very quickly.) No way are we getting that kind of day length right now, but we just passed winter solstice so things are looking up. T-shirt weather is just around the corner.

Chickens are biologically a lot like mammals, but it is fun to note the little differences. They don't have teeth, of course, so use a muscular gland called the ventriculus (gizzard) to grind their food. They don't have sweat glands, and on hot days I often see them panting like dogs to dissipate excess body heat. Their normal body temperatures run extremely high, 105 to 107 degrees. Normal resting heart rates can range from 280 to 340 beats per minute.

The process of "making an egg" is pretty cool. After a rooster mates with a hen, sperm can remain viable in the oviduct for up to 20 days, fertilizing eggs the entire time. Roosters aren't "required" for hens to lay eggs, only to fertilize them. I have had chickens (and plenty of those marvelous, fresh eggs) for 10 years and this is the first year I have ever had a rooster. Viggo is a handsome son of a gun-and he sure knows it! Only the left ovaries are functional in chickens, and they consist of about 2,000 small ova in the immature bird. As they mature, follicles form-these will be the yolks. There are usually 4 - 6 yolks forming at a time, the largest one will be the next egg. The follicle is covered by a highly vascularized membrane except for one area, the stigma. At ovulation, the follicular membrane ruptures at the stigma, but if it ruptures anywhere else (any place where there is a lot of vessels) we will see that tiny spot of blood in the egg. The blood spot doesn't have anything to do with being fertilized or not.

After ovulation, the yolk moves through the first part of the oviduct, the infundibulum, just like the start of an assembly line. If fertilization is to take place, this is where it happens, as well as the production of the first layer of albumen. It takes about 15 minutes for the yolk to pass through the infundibulum. It next passes through the longest part of the oviduct, the magnum, where most of the albumen is formed and deposited around the yolk. The egg is in the magnum for 2 to 3 hours. The egg now goes to the isthmus where the inner and outer shell membranes are formed, taking about 1 1/2 hours. Then the egg enters the shell gland or uterus. Here the egg will take up salts and water in a process called "plumping" and the hard shell is added. This, along with the final calcification of the shell, takes about 18 to 21 hours. Mature female chickens have specialized bone called medullary bone which forms 10 days prior to the formation of their first eggs. This is where they will store the needed calcium for egg production-roosters and immature females do not have this kind of bone. Finally, the egg passes into the vagina, where the cuticle layer is added over the shell and the egg turns 180 degrees (so that the large end is delivered first.) Wow. A pretty amazing process, huh?

Another thing I found interesting is that the natural skin pigmentation of a hen (called xanthophyll) is gradually lost during the laying season as that pigment is diverted to the yolks, giving them their characteristic yellow color. Corn is the major component of laying birds' diets and is a principal source of the pigment. Hens that are thoroughly bleached out are usually the highest producers. Her pigment will return as she stops production-one of the ways you can determine which hens have stopped laying if you will be culling or removing older birds from your flock. I'm not very practical at all-my old girls don't have to worry about "earning their keep." They will have a home for life, eggs or not.

I don't get the opportunity to do much chicken veterinary care on birds other than my own-most people probably don't want to spend the money. Chickens are a lot like other birds and "exotic" pets-they tend to hide their illnesses from us, sometimes until it is too late to much about it. They think if they show they are vulnerable, they will get eaten by a predator. Care must be taken to really know your individual bird's habits, if not personalities, so you can recognize when things change. Even subtle changes could be the indicator of an illness. Good nutrition and proper housing go a long way to keeping your flock healthy. Mine enjoy the popcorn from when I go to the movies and LOVE left over spaghetti noodles-maybe they think they are really long worms!

Like I said, Viggo and his ladies certainly will be celebrating the thaw, finally getting out and stretching their wings a bit. I sure enjoy my little farm.

Peace,
DrReneigh

Wednesday, December 24, 2008

Merry Christmas!


Winter weather and short days always make me want to hibernate-hole up by the fire with a good book or a knitting or crochet project. Exercise is definitely NOT in the picture. I was a California girl-sunshine and beaches are what get me up and moving. And then there are all those holidays with all the yummy comfort food. Of course, it is no surprise that my weight goes up at this time of the year-just like it does for many of my patients.

Little Bear is a darling, happy dog that has battled numerous health problems in her 7 years-and most of these can be related to her obesity. Her owners had trouble realizing she was overweight at all She is a Pomeranian and has a thick, fluffy hair coat-kind of like me wearing a big, heavy sweater, her coat hides a lot! When she was quite young, Bear had surgery on both knees to correct a condition she was born with, medial luxating patellas, where both knee caps moved towards the inside of her legs. Her recovery from the surgery was fine, but over the years, all her extra weight has put a lot of wear and tear on those vulnerable joints. She has also had two surgeries to remove cystic calculi or bladder stones. These tend to form in animals fed lots of table scraps, altering the urine pH, thus allowing the urine to crystallize. Earlier this year, Little Bear started limping on a front leg, and we found she had significant DJD or degenerative joint disease (arthritis) in her carpus (wrist.) Normal dogs bear about 70 percent of their body weight on their front legs. Dogs like Bear who have orthopedic conditions in their hind limbs, such as her knee problems, or labs with hip dysplasia will put even more weight on the front in an effort to get stress off the hurting hind legs. This is likely what happened to Little Bear's front leg. Bear's owners also told us they noticed she was having trouble breathing lately; I suspected this, too, was related to her excessive weight. Our blood work to assess her overall health showed that Little Bear was hypothyroid, or had an underproducing thyroid gland. This was undoubtedly contributing to her weight issues as all of metabolism is slowed down in hypothyroid dogs.

Now, we aren't talking about a lot of weight here. Little Bear is a Pomeranian after all. A healthy weight for her would be around 6 or 7 pounds; she has been weighing in over 9 pounds. 3 pounds doesn't sound like much, but it would be similar to me weighing in at 280 pounds! This is a significant percentage, and her quality of life was obviously affected. We showed her owners how to assess her body fat, feeling over ribcage for her now non-existent ribs-currently padded by a layer of fat. Ideally we would be able to feel the ribs under the skin. It would be hard to see her body silhouette with all that fluff, but in short haired dogs, you would want to see a tucked up flank and a "waist" when looking down at their backs. Her owners were of course concerned about all of her health issues and her quality of life.

Little Bear was in a viscious cycle many humans understand-exercise is difficult because of the pain/discomfort on the joints, but it is essential for weight loss. And boy, does she love her snacks! We put her on a thyroid supplement and a low calorie food and had her weigh in with us every month. But with her relative inactivity, her weight just didn't budge. When Bear's weight actually increased one month, we talked to her owners about the next step-adding a fairly new medication for weight loss in dogs.

I am not one to use medications when they aren't necessary. Diet and exercise are, of course, essential tools for weight loss and should absolutely be adhered to by the overweight dog's owner. But obesity is a severe health issue, as you can see from all of Little Bear's problems. Slentrol (dirlotipide) is a weight loss medication approved for use in dogs only (nope, we can't use this in fat cats or fat humans) to help when all other attempts have failed. It works to suppress their appetites-which sometimes concerns owners who are used to having overweight dogs that scarf down food eagerly. They become concerned when their dogs actually walk away from partially emptied food bowls-something must be wrong! Maybe they aren't feeling well! I'll have owners actually add some gravy or broth to the food to entice the dogs to eat more! You can see that prescribing this medication is often all about training the humans what is an appropriate amount to feed their dogs in the long run and implementing new diet and exercise habits. Once the new habits are learned and a goal weight is achieved we can stop the Slentrol and just feed the appropriate amount of food-the amount the dog told us they needed.

Like any medication, Slentrol is not without its side effects. We carefully monitor dogs while they are on the drug, including weighing them in every 2 weeks or so to ensure they aren't losing weight too rapidly and have no vomiting, diarrhea or lethargy. We will check blood work to be sure no organs are being affected by the drug. We haven't used much Slentrol yet, but since obesity can be a life-threatening issue, I expect this will change. We started Little Bear on a low dose of the medication, saw an initial small weight loss, but then a plateau. We discussed her case with the veterinarians at the pharmaceutical company who developed the drug, mentioning her bladder stones, thyroid issues and obesity. We have slowly increased her dose of Slentrol and she finally started to lose again. She is handling the medication just fine-Bear is as happy as ever and her owners are noticing her limping less and being much more playful as the weight is coming off. That is exactly our goal-improved quality of life, for as much quantity as we can get. Little Bear is fortunate to have such dedicated owners who are committed to her care and now understand how weight is an important part of that.

We are closing up the hospital early this afternoon and sending everyone home to spend time with family and friends. We have a few critters boarding with us, including our "sweet" diabetic cat, Cooper, who is a bit of a challenge. It seems he gets a bit stressed here and doesn't eat well. (who can blame him? It can be a scary place with the barking dogs, weird sights and smells.) That really affects his blood sugar level and thus his need for insulin. My entire staff is helping during the holidays by keeping him eating, learning to monitor his glucose levels and administer insulin only if it is needed. His owners have entrusted us with his care and we sure want to do our best for him and them. The rest of the critters will get fed and walked and played with while their owners are away. Merry Christmas everyone.

Peace,
DrReneigh

Tuesday, December 23, 2008

Is Your Bird Trying to Kill You?


I'll probably jinx myself by saying this, but I never get sick. I am fortunate to be made of hearty stock I guess. My employees will all tell you-they have rarely seen me with a cold, I've never had the flu, and being the only doctor here, haven't had the luxury of "calling in sick" for a day or two, (but actually haven't ever needed to. Even when those nasty "bugs" go around the hospital, knocking everyone on their butts, my immune system seems to hold them off-pretty darned lucky. That is why, around 10 years ago, when I started feeling feverish and achy all over, I really wondered what was going on. I started sweating so much that my ears filled up with water-how gross is that?! I just saturated the sheets on my bed, began to cough violently and couldn't sleep. When I started having trouble breathing, I dragged myself to my doctor.

My doctor at the time was wonderful. She ordered up chest radiographs (x-rays) and they showed that my lung spaces were totally obliterated by fluid. I had pneumonia. My doctor wanted to hospitalize me, but I was dead set against that. I figured with my immune system being so challenged right then, the hospital was a pretty crummy place for me to be. I didn't want to be around a bunch of sick people! So my doctor had me come in daily for injections of high powered antibiotics.

You are probably wondering what I am doing telling you about MY illness. This is supposed to be a blog about veterinary stuff, right? Well, hang with me for a bit and you'll see a connection.

I remember this happened in the winter because my husband drove me to the doctors on Valentine's day to get a shot in the bum-how romantic! But those injections just didn't cut it. My fever climbed to over 105 degrees. I was kind of hallucinating. My doctor was frustrated. She ran blood work and repeated the chest films-there just wasn't any progress. Now my doctor knew what I did for a living, and she suspected I got myself exposed to some nasty animal organism, maybe one she wasn't as familiar with as I might be. She asked me if I had been around any "exotic" animals lately, and I really couldn't think of any-but I wasn't thinking too clearly. We got out my textbook on zoonoses-diseases animals and humans can transfer to each other. It is true that veterinarians study this topic in much greater depth than do human physicians.

One disease sparked our interest-psittacosis, an infectious disease carried by birds. I then remembered a young bird I had attempted to treat a couple weeks prior. In fact, I had given the bird, a beautiful white Cockatoo who was struggling to breathe, CPR-or mouth-to-beak resuscitation. I had likely inhaled some of the bacterial organisms into my own lungs during the procedure. The young bird didn't survive. Little did I know that the bird wanted to take me with her! Once we connected the dots, we realized all the fancy antibiotics weren't appropriate for my treatment (obviously-they weren't working!) The treatment for psittacosis in humans as well as in animals is a very old, very common antibiotic called tetracycline. No more shots in the bum! Just a day or two after starting these antibiotics my fever came down and I started to breathe much easier. I don't often get sick, but when I do, watch out!

Zoonoses, those diseases we humans share with animals, are actually quite common. Intestinal parasites such as roundworms and hookworms can be shared across species. Dermatophytosis or ringworm (not actually a worm but a fungal organism) is a highly contagious skin disease seen frequently in cats (but again can cross many species.) Bartonella or cat scratch fever is a nasty bacteria that makes cat bites and scratches so serious. Bovine spongiform encephalopathy (BSE) or mad cow disease is the fatal disease associated with eating affected beef. Rabies is the viral neurologic disease we vaccinate most of our pets against, primarily for human health reasons. The list goes on and on.

There is some great information about zoonotic diseases at the website for the Center for Disease Control (CDC):
http://www.cdc.gov/healthypets/

The American Veterinary Medical Association has public health information at:
http://www.avma.org/public_health/default.asp


Make sure your pet is healthy and stays that way by working closely with your veterinarian. Yearly examinations, current vaccinations and regular deworming protocols will go a long way towards lowering your risks (and maybe think twice before giving CPR to a dying Cockatoo!)

Peace,
DrReneigh

Monday, December 22, 2008

That Embarrassing Acne



I remember how awful it was, usually on a very important day like the prom or class pictures, getting that humongous red zit smack dab in the middle of my forehead for all the world to see. Of course, most of my classmates were probably battling their own self esteem issues and no one cared a wit about my forehead. But it sure felt like everyone was staring at me despite all the concealers and Clearasil ointments.

I wonder if cats suffer the same feelings of embarrassment when they get outbreaks of acne. Yep, cats get acne just like we do, and Mixer is a great cat that came in today for just that reason. He was probably due to have Christmas pictures taken or something else really important, the poor guy. Cats usually have a pretty severe infection localized to the chin, and Mixer was no exception. His entire chin was filled with comedones (black heads) and pustules (white heads) and was swollen and very sore. When we shaved the hair from the affected skin, we saw it was all purple and there was evidence he had been rubbing or scratching at it, just making the condition worse.

Many cats develop the acne in response to an allergic reaction or a sensitivity to their plastic food bowls, so we advised Mixer's owners to change these to ceramic or stainless steel. We also told her it would be very important to keep those dishes meticulously clean, as that greasy residue that builds up on the bowls from the oily foods can also be a trigger for some cats. (I'm guilty of just filling the bowl over and over as Spartacus and Stella are screaming at me-Mixer's condition reminds me that I should do better about changing bowls and keeping them clean.)

Some cases of feline chin acne respond well to topical medications-benzoyl peroxide, just like in our Clearasil products but at a different concentration to avoid burning the cat's skin, can be used. That is one reason we shave the hair off this area-it is much easier to put ointments on the skin without hair getting in the way. It also helps us monitor the healing much better. Mixer's condition warranted systemic antibiotics as well as some antiinflammatory medications to take down some of the swelling and discomfort. We also put him in an Elizabethan collar or satellite dish to prevent him from more self trauma (and also to keep him from grooming off the topical medication.)

We'll check back with Mixer's owners in a few days and be sure he is getting his medications OK and not having any reactions to them. One complicating factor is that Mixer happens to have FIV or Feline Immunodeficiency Virus. His immune system is not normal, so any infection he gets may be more difficult for him to handle. His owner knows this, thus the immediate appointment when she noticed the problem on his chin. We will have them come in before the medications are finished to be sure we have a complete cure; if there is any chance some infection remains, or if it just isn't getting any better, we may have to culture some of the pustules to see if we have a resistant infection (MRSA or multiple drug resistant staph has been reported in some of these cases.) Hopefully we will have him smiling pretty and have his self esteem boosted in time for those Christmas photos. He is a handsome dude when his chin isn't swollen and purple.

Peace,
DrReneigh

Friday, December 19, 2008

Layla is Getting Fat


Layla's owner braved the icy roads to come see us this morning. Layla was happy, healthy, sassy and.....fat! She has an excuse, though. Those radiographs (x-rays) of her abdomen (belly) should give you a pretty big hint. Unless she had just gotten into the garbage with a turkey carcass or something, there sure shouldn't be BONES in her belly! That is, unless she were pregnant, and that she is.

We had confirmed this a few weeks ago by doing ultrasound, very similar to how human pregnancies are monitored. I usually have my breeder clients bring in the females they suspect are pregnant at 3 - 4 weeks along for the first pregnancy check. At that time there isn't much to see, just small black vesicles or fluid-filled structures with peanut-sized puppies floating inside, but boy, do we get excited about those "peanuts!" If the mamma isn't too nervous, (and therefore panting like crazy while we do the scan) we can often see little heart-beats and visualize the feti moving around a bit in their fluid compartments. It is difficult to get an accurate puppy count at this time-the vesicles are just too small and mobile. We can't be sure if we are counting the same one over and over while others might be hiding up under the rib cage or elsewhere in that big belly.

So if all is well, we schedule a puppy count radiograph around day 58-60, just before they are born (usually around day 63.) This is very useful so we will know about how many to puppies to expect when she begins whelping (delivering.) If there are any problems or she seems to stop contractions, it is helpful to know if there should be any more puppies or not. The little puppy skeletons just start to mineralize at day 45 or so (and may be faintly visible on the x-ray film.) You don't want to wait so long that she goes into labor, so day 58 is about perfect. Sometimes, especially when there are very large litters, puppies are all over the place on the x-ray, seemingly on top of each other, really making it difficult to get a count. We do the best we can.

I like to count the visible skulls as a way of not confusing the issue too much. If you zoom in on the belly (click on the picture to view it larger) on the V/D (ventral/dorsal) film above- the one with the diaphragm at the top and the pelvis just visible at the bottom, you will barely see two puppies on the left and one on the right. (The right side is HER right side-as if you were going to shake hands with her.) The little rib cages are more obvious on this view than are the skulls. The lateral or side view shows 2 skulls caudally (toward her tail end) and one just under her ribs.

Three is just about right for a small breed dog and a first time momma as is Layla. Any fewer and the pups might grow too large in the uterus, making it difficult to whelp naturally. Any more and she might have trouble nursing and caring for them all (although dogs have certainly nursed much larger litters just fine.) Anyway, Layla's owner is very pleased and so am I. We are expecting puppies right around Christmas Day-that will be a pretty great present all around.

Peace,
DrReneigh

Thursday, December 18, 2008

Some "Big" Problems


Several years ago, Michael and I went to our local zoo for an early morning visit. I remember this particular visit because of a funny incident in the elephant house. One big female was being examined by the veterinarian because she was pregnant. I was doing a lot of this kind of work every day at that time, just on a smaller scale. My patients were "only" one thousand to fifteen hundred pounds-horses and cows! It became evident that the zoo veterinarian was going to do a rectal examination on this elephant to get a feel of the fetus and help assess how the pregnancy was going. He placed a ladder behind her and got out the tell-tale shoulder length plastic glove. My husband laughed and said he likely had the only wife in the "audience" that wanted to jump right in and help-and had her own personal supplies to do so. We hung out and talked to the doctor after he was done. He said that this elephant was too early in her gestation (elephants are pregnant for about 22 months) to feel anything cool and his ultrasound unit was on the fritz. He was more just getting her used to the handling than anything else. It was pretty interesting.

Some basic procedures veterinarians take for granted as part of a standard physical exam in their patients just can't be done (or have to be done is some other way) when those patients are elephants. If an elephant weighs much more than 6,000 pounds, and many do, you can't auscult or listen to the heart by placing a stethoscope up to the chest wall. You also can't take an accurate rectal body temperature. Instead a temperature is measured on a freshly passed ball of manure, usually 97.5 to 99 degrees F. You certainly cannot palpate abdominal organs or use an otoscope to look at the tympanic membrane (ear drum.) Even just getting a body weight takes special equipment-truck scales are often used.

A typical examination of an elephant starts by simply watching the patient, observing behavior, gait and body condition from a distance. Discussing the patient with his or her handler is very important; they often know idiosyncrasies or what is or isn't normal for that particular elephant. For example, an elephant might flap their ears out of annoyance (kind of like a cat twitching the tip of their tail) or because they are trying to decrease their body temperature-an experienced handler better be able to tell the difference.

Elephants just naturally move all the time; swaying or weaving consists of moving back and forth, alternating weight from one leg to another and isn't likely a sterotypic behavior as it can be in horses or those wild cats you see pacing in their enclosures. Elephants need to do this to facilitate circulation from their limbs to their heart-a pretty great distance! One study showed that when elephants move from foot to foot, the "down" foot increases in diameter by 9%, causes the digital cushion of the foot to compress and forces the blood up the leg, greatly assisting return flow back to the heart. Pretty cool, huh?
Since you can't listen to a heart, feeling for a pulse on an auricular (ear flap) vein-normal resting pulse rate is 25 to 35 per minute. Normal respiratory rate is about 4 to 6 breaths per minute. Feet and teeth can be examined as part of the physical if the animals are trained to allow it safely.

Elephants have toenails, not hooves like horses or cattle. They and their cuticles should be kept trimmed and observed for cracks, misshaped or discolored nails. Elephants only have 6 teeth at a time (4 molars and 2 incisors,) but they get 6 sets of them through out their lives. It is normal to find that the skin of older elephants becomes de-pigmented and may develop freckles, particularly on Asian elephants. They also develop small warty growths on their trunks, again, a normal aging change. Male elephants are the only land mammal to have intra-abdominal (internal) testicles, found adjacent to the kidneys. It is important for anyone working around bull elephants to know of their "musth" periods-times when bulls, usually after age 15 years or so as they sexually mature and occurring once a year for 1 - 2 months, become aggressive, destructive and dangerous. Signs of musth are mood or behavior changes, decreased appetite, constant dribble of urine, temporal glands on the forehead become enlarged and draining, and a strong odor due to the glands and urine.

Captive elephants are vaccinated against tetanus and rabies and are routinely dewormed against intestinal parasites. They can get tuberculosis and herpesvirus as well as other infectious diseases. Elephants are just way cool animals and I thought some of these things were pretty interesting. I hope you, my fellow bloggers, found that as well.

Peace,
DrReneigh

Wednesday, December 17, 2008

Don't Leave Me Alone!



Are you seeing some of those heart-wrenching ads asking to support shelters/humane societies on TV lately? Close ups of emaciated dogs, tragic eyes peering through cages, scared kittens in corners of alley ways...all accompanied by sad music just designed to bring tears to your eyes (and open wallets for big donations I assume.) They get to me way more predictably than the same kinds of pleas for help for the starving children in Africa, homeless people, blah, blah, blah....Don't get me wrong, I support HUMAN charities, too, mostly through my church, but you have to draw the line somewhere, and those abandoned or lost, usually neglected if not abused animals really sucker me in. And that's OK.

Did you realize most animals surrendered to shelters are done so not due to lack of space, owners moving or health issues in the pet, but because of behavior reasons? Many of those behavior problems were likely preventable if they were dealt with early on, however a lot of owners might not know (or may be too embarrassed to ask) about help for the problems. Because surrender to a shelter could easily result in euthanasia due to overcrowding situations, behavior problems should literally be considered life and death issues.
One behavior situation I seem to be seeing more of is a condition known as separation anxiety. No pets like to be left alone when their owners leave for work or go out for an evening, but some become so agitated that it becomes a pathologic situation needing veterinary treatment. Signs of separation anxiety are:

-hypersalivation or excessive drooling, so much so that you may see pools of saliva around the house or in the crate and your pets may be dehydrated from the loss of fluids
-vocalization or barking, whining or howling, often in a single tone that doesn't change much in pitch, and can be so loud that the neighbors will complain
-elimination, voiding urine or feces in the house or crate, often in multiple areas since the pet is likely pacing anxiously if allowed free run of the house. The feces may be diarrhea or be slimy or even blood-tinged due to stress
-destructive behavior that is directed towards personal items such as clothing, pillows, furniture, books or at means of exit from the house such as door and window frames

Recognizing that these behaviors are done out of anxiety in the pet and not out of a sense of "anger" or "punishment" of the humans for leaving them behind is important in treating this condition. It isn't appropriate to get mad at your pet or punish them for the behaviors after the fact. They just won't "get it" and your anger will only make them fear you. We start with some basic behavior modification, reducing your pet's excitement associated with humans coming and going and adapting them to being alone. Try to make coming and going from the home a non-event. Don't pay attention to the pet for about 5 minutes after arriving home or until they are relaxed. This can be awfully hard-who doesn't love that excited, wiggling and barking greeting we get, so full of love? My husband sure doesn't greet me as excitedly as Verbal does!

Consider activities that trigger the anxiety reaction in your pet such as picking up the keys or putting on your jacket that you do right before you leave-try doing these numerous times during the day without leaving so they will no longer be associated just with you leaving. Try leaving a toy that delivers little bits of food over time as the pet works on it or peanut butter in a Kong toy-these are great distractions if the pet is food motivated. If the crate is considered a safe place for your pet, use it! Many pets settle right down when they don't have to "guard" the whole house, and you won't have to worry about messes or damage elsewhere. If your pet has had bad crate experiences, we may need to work on that. Sometimes just moving the crate to a new location works well.

There are supplements and medications which, along with behavior modification, are used to treat separation anxiety. Pheromones are chemicals secreted by animals to communicate between species. DAP for dogs and Feliway for cats have mixed results in calming animals in various situations and can be found in sprays, plug in diffusers and even collars.
Medications tend to work on serotonin, a neurotransmitter or chemical that sends information from one brain cell to another. Just like in humans, it is believed that serotonin is low in pets with anxiety disorders. There are many drugs available and one, Reconcile, is FDA approved for dogs with separation anxiety. Reconcile, (generic name fluoxetine) also known as Prozac in human medicine, may take 3 to 5 weeks to take full effect, but helps to improve your dog's receptivity to the training plan. It is not without its side-effects, however, so you and your vet will have to monitor your pet carefully while on it.

I really enjoy working with owners on behavior issues- they can literally be life saving consultations when plans all come together. Be sure to include your veterinarian in discussions about behavior issues that crop up in your pet's life as they can be just as important as limping or itching or any other health problem.

Peace,
DrReneigh

Tuesday, December 16, 2008

Scooter Weighs In


Scooter is a long time patient of ours, a wonderful, handsome black cat with a human so loving and dedicated to his care it is awe-inspiring. She has done everything we have asked of her in the course of his care, including braving the slippery icy roads today to bring him in for his monthly weigh in. No, Scooter is not a fat cat-at 9 pounds he is just about right. We weigh him in every month because he has what every human dieter could only wish for-(not really, it can really be a serious condition as you will read about Scooter- but as some one who has battled weight issues my whole life, just a "little" bit of his condition sounds appealing....) Scooter has hyperthyroidism.

Hyperthyroidism is a disease of the thyroid glands, usually due to a benign mass or tumor that produces too much of the hormone responsible for, well, virtually all of the metabolism in the body. It can affect so many systems and organs, but we primarily see patients for the first time because they begin to lose weight despite often having great appetites. I have seen cats lose almost half of their initial body weights. They can develop cardiac (heart) and hepatic (liver) issues. Hyperthyroidism is almost always seen in cats; dogs usually have the opposite condition of under production of the thyroid hormone-hypothyroidism. Hyperthyroidism is actually quite common in our older cats; it can be seen in one out of every 300 or so, and the average age at diagnosis is 13 years. Scooter was 11 when his owner brought him in for his yearly health exam and vaccines, but we noted this once 14 pound cat was down suddenly to 11 pounds with no diet change or anything else to "explain" the weight loss. We typically screen all of our senior or geriatric patients after the age of 8 years or so with a simple blood test, and we did so for Scooter. Sure enough, he had a slightly elevated T-4 level. This was over 2 years ago, and was the beginning of our "journey" with his disease.

There are three basic treatment options for hyperthyroid cats, and the choice for an individual cat is made based on location, difficulty in medicating the patient, (those darned cats!) how the cat tolerates the medication, as well as owner finances. We explored all three options with Scooter over the last two years. Initially, all cats go on a medication called Tapezole or methimazole to help stabilize the patient by bringing the T-4 level down. It can be expensive and, while transdermal (preparations rubbed into the skin of the cat, usually the hairless inner ear flap) formulations are available, they aren't likely to bring blood levels of the drug up to therapeutic levels. So that means getting a pill or multiple pills into your cat every day. We were fortunate in that Scooter was a good boy and his owner did not have a problem getting his pills in him. The bigger problem with methimazole is it can be toxic to the kidneys over time, and this was the case for Scooter. Cats often have issues with renal (kidney) function as they age, so medications that could exacerbate this just aren't a good idea long term. We had to take Scooter off this medication and look for another treatment option.

Radioactive iodine therapy is the "gold standard" of hyperthyroid treatment-for cats as well as for humans. I heard that the first President George and Barbara Bush had this treatment! We are very fortunate that there is actually a center for hyperthyroid treatment for cats very close by. Not all patients are as lucky and owners might have to travel great distances for referral to facilities that offer this treatment. The benefits of radioctive iodine are significant: a cure rate of 90 to 95 percent, with no further treatment needed in most cases. Yes, it can be expensive, but the costs seem to have come down over the years as the average time the cats are hospitalized has gone down. The cat gets one dose of a radioactive substance that kills the overproducing cells. This only takes a day to perform, but because the patient will then be "radioactive" for some time, isolation is often recommended to prevent human exposure. This is especially important for exposure to the cat's waste products-urine and feces. You also don't want to allow your cat to sit on your chest for prolonged periods or cuddle up next to you to sleep, as Stella and Spartacus are doing right now to use my body heat! The doctors and staff at the treatment facilities are great at explaining the aftercare required. No, the kitties don't glow in the dark :)
Scooter's owner took him for a consultation to our local treatment facility, but he was found to be unsuitable for treatment due to some already elevated kidney values. That was two strikes against poor Scooter!

The third option for treatment is surgery to remove the tumor or overproducing tissue. It can be a very good option, especially if radioactive iodine therapy isn't available or suitable as in Scooter's case. Problems are it can be a delicate procedure, (there are some HUGE blood vessels in this area-the jugular vein and carotid artery) and because very tiny adjacent and embedded glands called the parathyroids are often removed along with the thyroid gland. These are very important for calcium regulation in the body, so this must be monitored carefully post-operatively, especially if both thyroid glands need to be removed.

Scooter's owner elected to take him to surgery a few months ago. His weight had dropped another 2 pounds despite her aggressively searching for foods he would love (doesn't it figure he would be a typical finicky cat?). His body condition actually looked pretty good, but we knew how that could change if we left his disease untreated. Scooter did great for his surgery, good anesthesia and all, but we had a big problem-we couldn't find his thyroid glands! Usually located in the neck or just at the thoracic inlet near the throat, affected glands are usually abnormally large, discolored, very obviously "not right" and just sort of pop out at you. They can often be palpated (felt) during a physical exam, an important part of checking over a senior cat. I knew that the glands could rarely be located in the chest cavity itself, and we weren't prepared for the type of extensive anesthesia and surgical exploration it would require to go blindly searching for them in such a large space. Their location can be identified ahead of time by doing a scan (injecting the patient with a contrast media and taking images to identify the tissue that picks up the dye.) This has to be done by a specialist in this type of imaging and can be very expensive. I have never had a patient referred for this, but after Scooter's surgery, I am considering it (if Scooter's owner can afford it. She really has gone above and beyond what most owners would do for their pets and times are tough right now.)

So, now what? Scooter has run out of his treatment options for now. His owner is distraught, but she is doing a wonderful job of pumping calories into him. She gives him appetite stimulant medications when he needs it, and all sorts of tasty foods. And guess what? He is up 8 ounces at today's weigh in! That is pretty significant in a 9 pound animal. He'll never be a 14 pound cat again, but that is OK-he was really too fat back then. We'll give him a break and extend out his weigh-in appointments to every few months or so, or anytime his owner thinks he might be getting finicky again or having problems (he still has those kidney issues to deal with.) And I'll keep going to seminars and consulting online for any new ideas the endocrinologists/internal medicine specialists might come up with to help him. He is one lucky kitty to be loved and cared for this much.

Peace,
DrReneigh

Monday, December 15, 2008

Kadie's "Episodes"


Kadie is a happy, beautiful (yep, I suppose that goes without saying!) Golden Retriever. Her owners noticed over the course of 2 years she has had multiple instances of possible seizure-like episodes. Kadie likes to spend most of her time out doors, so she could very well have had others that weren't witnessed by her humans. The one that brought her to us today was pretty typical of all the others. It seems she was just doing something normal, today it was drinking water, when her hind legs collapsed out from under her, followed by her front legs collapsing. Then she fell to her side and began paddling with her legs. The episode didn't last long, and her owner wasn't quite sure if Kadie was conscious throughout the episode or not. She seemed to be. She didn't lose control of her bowels or bladder, but she had at other times. Maybe it was because she had just come in from being outside that she didn't urinte this time. Who knows? We hadn't done a thorough physical exam or blood work on Kadie in quite some time so when Kadie's owners called to tell us of this occurrence, we advised them to bring her right in. They were very worried, as any of us would be.

Kadie seemed happy enough during her exam, as all good Golden's generally are. It was concerning that she had lost over 10 pounds since we'd seen her last, but her weight was good at this time-not too thin at all. She had no obvious neurological problems, her pupils responded normally to light, her feet righted themselves when placed upside down, a test of proprioception or "knowing" where her feet were in space. She could walk normally with out obvious swaying, tripping or wobbling, and there were no residual tremors. She did not show any signs of fear or pain, and her abdomen palpated fine-no obvious masses. We ran a complete blood panel which was essentially normal but couldn't get any urine-her bladder was still empty.

Ideally we would like to get a scan of Kadie's brain to rule out any brain lesions as the cause of these episodes. MRI's are fairly common in human medicine-I had one earlier this year on my shoulder after an auto accident. But they are expensive tests and would require a referral to a neurologist and a general anesthesia for Kadie-asking her to sit still for the time required to produce the scan just isn't possible in even the best behaved dog. I can think of only a handful of patients that received an MRI this year, including CJ, a way cool Border Collie with a spinal cord lesion that turned out to be an abscess only identified via surgery and biopsy and Prince, a Dachsund with a very serious (and common) intervertebral disc rupture and subsequent paralysis. I may write about these guys some other time as they were very interesting cases. Kadie won't be getting the expensive MRI at this time, but that's OK. Her history, her normal blood results, and her breed make her diagnosis of primary epilepsy a bit more likely, so we start off treating for that and see how she does.

We are going to start Kadie on an anti-convulsant medication called phenobarbital. It has been around for a long time, so we know a lot about how it acts in most dogs, what to expect for side effects, and how to monitor the blood for effects on her body long term. It can have effects on the personality of some dogs, but thankfully, these are usually transitory, going away after the first 5 to 7 days. If they don't, or if her blood work shows the effects on her liver becomes too toxic, we have numerous other anticonvulsant medications we can try. This is just a good place to start. The goal is to eliminate all seizure episodes, as every time she has one, Kadie lowers her "seizure threshold." This means that each seizure predisposes her to have another one, possibly another one more severe, or of longer duration. That is a scary thing for an owner to see, and such a helpless feeling not knowing what is going on or how to help. Hopefully Kadie's new medication will help her right away so she won't have to worry her owner's any more. Or worry her veterinarian!

Peace,
DrReneigh

Friday, December 12, 2008

Meile's "Tummy" Hurts


Meile is a darling, happy (aren't they all?) yellow lab who is REALLY hurting today-and all because of that yummy, very fatty marrow-filled beef bone she ate way back at the beginning of the week. You would think if she was going to be sick after eating something, it would have been right away, but Meile doesn't have gastritis (an upset stomach) or enteritis (inflamed intestines). She has a disease that can happen a few days after over doing a very rich or fatty meal. Meile has pancreatitis.

The pancreas is an endocrine (glandular) system organ that sits under the stomach. Its main function is to secrete enzymes that help digest food, especially fatty ones. The pancreas is also responsible for producing insulin and glucagon, which is important for blood sugar metabolism as we discussed with our "sweet", diabetic cat, Cooper.
In pancreatitis, the usually pale pink organ becomes inflamed and the digestive enzymes it normally stores are released prematurely. This can cause living tissue surrounding the organ (usually the stomach, liver and intestines) to become damaged, literally being "digested" by itself. Toxins are released from this process and as tissue is destroyed the entire body has an inflammatory response.

Many things can cause pancreatitis, and sometimes we never find the cause. Some breeds of dogs such as Schnauzers are actually more likely to get this disease. While Meile is not a Schnauzer, she showed the classic signs of pancreatitis, vomiting, diarrhea, and abdominal pain. When I palpated her abdomen in the exam room, she kind of grinned at us, licked her lips as if she was nauseated, and sure enough, vomited again about a minute later. The poor girl. We started her therapy before we definitively knew her diagnosis; we gave her an injection of an anti-emetic (anti-vomiting medication) right there in the room. Meile was actually vomiting a lot of foam tinged with blood. Vomiting is no fun for anyone and I wanted that symptom stopped ASAP.

Meile was a very good girl for her nurses as we went about the job of collecting blood samples and taking abdominal x-rays. (Her owner couldn't be sure she didn't swallow some type of bone or rock or even a tennis ball, so radiographs helped us rule that out.) The blood tests were not definitive (exact) in their diagnosis, but that is often the case. Putting all the information together, the history, (what the owner tells us) the exam findings, the radiograph and blood work results....it all added up to pain in the cranial abdomen-just where the pancreas sits.
As it sounds, pancreatitis can be very serious, even life-threatening in some animals. It is also very painful. We know that untreated pain can affect the immune system, so pain management is a very important part of the treatment plan. Meile really improved right away with her first dose of a narcotic pain medication.

It is also important NOT to stimulate the pancreas at all for the first few days of treatment; giving anything orally, even water, can easily cause this to happen. Taking Meile off all food and water today and giving her intravenous fluids has helped prevent dehydration and gave her much needed electrolyte support. She was also placed on antibiotics because even though pancreatitis is rarely a bacterial disease, bacterial invasion from the adjacent diseased intestines is a common occurrence.

We will continue to withhold food and water from Meile overnight and start her back on oral fluids and bland food very gradually only if she continues to do well-no vomiting or diarrhea overnight. There is always a potential for a chronic inflammation of the pancreas, so a long term use of a low fat diet may be necessary. Meile, like a lot of Labs, has some weight to lose after we get her over this illness, so the low fat diet will be perfect for both conditions. Meile is lucky because she has wonderful owners who got her in right away when they saw she was vomiting. I know they will watch her carefully and follow instructions to the letter, calling me if anything changes for her.

Meile isn't likely going to turn down a nice fatty marrow bone in the future-what Lab would? But it really isn't going to be a great idea. Her humans will have to be tough, enforcing her new diet and not giving into those sad, begging eyes. I doubt she'll starve anytime soon.

Peace,
DrReneigh

Thursday, December 11, 2008

All Good Vet Hospitals Have a House Cat


I guess we have a good hospital, then. Noodles has been with us almost since the start. She was a rescue (of course!) from a very disreputable breeder of Maine Coon cats in Canada. Some concerned breeders and showers of these magnificent cats had heard of some financial troubles this person was having and how difficult that made it for them to get proper veterinary care for there ever expanding household of cats. (Cats went un- neutered or spayed and bred uncontrolled.) In the hopes of helping at least a few of the poor animals, a rescue team went to their home and asked to take over the care of 6 of the kittens in the worst physical shape. Noodles was one of those 6. They all had a virulent case of ringworm, a contagious skin disease, as well as upper respiratory infections, and diarrhea. Several had head tilts from ear polyps, growths from the tympanic bulla, some bilateral (both ears affected.) Maine Coons are known for being one of the largest breeds of cats. These 5 and 6 month old kittens should have been healthy 4 and 5 pounders; Noodles was the "heaviest" at only 15 ounces! It was heart wrenching.

It took months of care to turn these little guys around. They got hundreds of medicated baths for the ringworm, thousands of dollars of surgery for the polyps and medications for the infections, but it was so worth it to see them fatten up and thrive. We adopted five of them out to good homes, but had I had fallen in love with Noodles and decided to keep her as our first hospital mascot. It seemed like such a great outcome to a horrible beginning for those babies. But it wasn't long before we were hit with heart break again; all 5 of the kittens adopted out eventually died from a disease called Feline Infectious Peritonitis-FIP. Feline infectious peritonitis is a syndrome that results from wide-spread infiltration of the body’s organs with a type of inflammatory tissue called pyogranuloma. The resulting global inflammation leads to the failure of the infiltrated organs, fevers unresponsive to antibiotics, and often an accumulation of thick yellow fluid in the belly or chest. The “wet” form of FIP includes the effusion of thick, yellow fluid as noted. The “dry” form is more insidious, leading to death over a much longer period (often years). Both forms are felt to have 100% mortality. Imagine a disease that is infectious yet not contagious, has 100% mortality, virtually no diagnostic test to confirm it, and no effective treatment. It is one of the worse diseases I have ever had to work with, and most veterinarians who have ever faced it feel exactly the same.

We don't know why Noodles was spared so far. It is entirely possible the disease is brewing in her body and will rear its ugly head someday, but for now we can only pray for her good health and enjoy her goofy anctics around the hospital. She has a bit of a crazy head tilt, a goofy shaped eye and is mostly deaf as a result of those polyp infections and surgeries, but all this adds toher character. She has no fear of the dogs that come to the hospital, no matter their size, and regularly tries to steal hospitalized or boarding patient's food (she has been on a perpetual diet for the last few years-she definitely made up for lost time weight-wise!) Many regular clients have to make sure to greet Noodles before they finish their visit or it just isn't complete. She is part of the package deal. She doesn't have a loud purr at all-the only way you know she is purring is to see her whiskers vibrating when she is being scratched under the chin or behind the ears. She HATES being picked up to be held or cuddled-don't even try. It is either because she is worried she will have some medication or procedure given or done to her or because she is extremely off balance due to her inner ear issues- she is not a snuggly cat. But it is all good. She is our Noodles, and she makes our hospital a "Good Vet Hospital."

Peace,
DrReneigh

Wednesday, December 10, 2008

Raquel, My Delicate "Little" Girl



Raquel had an appointment to get her feet trimmed today. Our farrier or horseshoer is a wonderful man and good friend who has taken care of her and her best buddy, Jesse the donkey, their entire lives. That is saying a LOT. Very few farriers will work on donkeys, fewer still will work on draft horses-Fred very generously does both for me. He has one of the hardest jobs I can think of, and he does it well, always with a smile, and usually with a new blonde joke for me. Thanks a lot, Fred. I feel so fortunate to have someone to care for my critters as he does. We met quite a while ago when I had Raquel's predecessor, my very first horse, Ladyhawke.

She, too, was a draft horse, a beautiful black Percheron mare that I lost in a very tragic circumstance. She actually broke her femur, the huge hind leg bone that connects to the hip. Lady was attempting to deliver her first foal, and must have slipped on the placental fluids or blood or urine. We can't understand the exact events, but know that when we checked her early that morning (she was boarding at a friend's home-she called me frantically when she realized Ladyhawke was experiencing dystocia, or difficulty giving birth.) When I arrived it was obvious the foal was not alive. I thought it may have been stuck in the birth canal as can happen with all those long legs, but she was delivered with an easy pull. Horses usually have to get up and down a few times to kind of "pump" the foal out. Lady must have been unable to do this early on in the course of foaling and the foal died from lack of oxygen. So tragic. Lady didn't attempt to get up, even when we were pulling on the foal. We assumed she was exhausted from her efforts as often happens, maybe depleted in her blood glucose or calcium. I placed an IV catheter (man, it sure is hard being "mom" and doctor at the same time!) and gave her large volumes of fluids with electrolytes, calcium and glucose. Friends and neighbors all worked together to encourage her to get up-to no avail. And if a 2000 pound horse doesn't want to do something, there isn't much us tiny humans can do about it.

At one point we had a neighbor with a tractor hook her up and drag her out of the stall to the pasture where we hoped she would have better traction. It was then that I noticed how her patella or knee cap luxated (moved inward) way too easily. You shouldn't be able to move a patella on a Chihuahua, much less a Percheron. I knew in my gut what it meant, but I called the local equine surgeon and asked his advice. He told me what I had feared. It had to be either a fracture of the femur or hip itself, and if we couldn't get her up, we wouldn't be able to transport her to the hospital for surgery. Even if by some miracle she could stand up, she wouldn't likely be able to do so for long enough to recover from a fracture like that, not with the kind of weight she was carrying. I had to make the hardest decision a pet owner ever has to make, just a few hours after learning we had lost her first foal.

I had been a typical "horse-crazy" girl growing up, but had never owned a horse of my own until my beautiful, sweet Ladyhawke. I had done things responsibly, I thought, buying her after graduating from vet school when I felt I'd settled down a bit and could really take care of a horse. I felt I had really failed my best friend. I will never forget my gentle giant. She was buried right there in my friend's pasture. One day I left some carrots on her grave and some yearling colts came over and nibbled them up-it seemed fitting!

Later that summer I was driving out in the countryside for some reason, and saw a pasture with some beautiful foals enjoying the sunshine. I pulled over to watch them and a woman soon joined me. She told me she felt "compelled" to talk to me, that she just felt I was destined to own one particular baby-the black Percheron filly with a tiny white star on her forehead. Now, I was still hurting pretty badly about my loss and I had NO desire to get another horse, much less a baby. But I humored her and chatted a bit. They sure were fun, gangly things like only draft horse babies can be. The woman even got out some paperwork on the foals, birth records and all. The pure black, 4 month old filly she had pointed out to me was born the day my Ladyhawke had died! Wow, what a trip. Maybe it was meant to be after all. I went home and talked to Michael, my husband. He was so cool about it. We didn't have much money at the time, but he had been saving a bit and put some aside with out telling me. He wanted me to be able to buy a horse when the time was right for me. What a guy! Needless to say, that fuzzy, gawky, stocky"little" baby became part of the family. We named her Raquel because we like to use Hollywood or movie star or movie character names for our critters; Raquel Welch was a very feminine sounding name and this very stout, bulky girl was going to need all the help she could get feeling a bit more girly. Her registered name is Dr. Renee's Lady Raquel, honoring her predecessor. She is now 11 and 1/2 years old-hard to believe! Michael fenced our property soon after we purchased this, our very first home. We are so fortunate! Her buddy, Jesse, the incredibly long eared, shaggy donkey, has been with her every day since she moved to our little farm. They are quite the pair. I did all of her training and was the first human to ride her-what an honor that was. She is relatively "small" for a draft horse, about 1600 pounds and standing 16.2 hands tall. (One "hand" is a unit of measurement equal to 4 inches.) I definitely need a step stool to do a thorough job of grooming her neck and back-and oh what a great neck it is! Great for big hugs and crying on her shoulder if you need to. And she is a dream to ride-kind of like riding a couch! We don't ride as often as we should, but I recently joined a "Meet-up" group of horse-loving people and I'm hoping that will soon change. My best friend, Kristen, who I've written about before, has an awesome horse, Harry, a Norwegian Fjord. It is a shame, but we have never been able to ride together because neither of us has a horse trailer! Maybe we will meet some kind-hearted, fellow horse lovers who will swap trailer rides for a tank of gas or something....we'll see.

Wow, I really wrote a lot tonight. You can tell when something inspires me-my own critters sure do that. I don't have the human kind of children, so probably put a bit more emotions into my relationships with my pets than may be "normal." Oh well, what is "normal", anyway?

Peace,
DrReneigh

Tuesday, December 9, 2008

There is No Such Thing As a "Routine" Spay

One of our patients, in for a spay procedure, tried to die on us yesterday. Thankfully, due to the astute observations and quick actions of the entire team, including the nursing care of her owners overnight, she is doing remarkably well today. There is no such thing as a "routine" spay.
Summit is a year old beautiful Bernese Mountain Dog. She had normal pre-operative blood work, had an IV catheter placed and was given some pre-emptive analgesia medication. Being a larger dog (90 pounds) her surgery was a little longer, but all went well and she recovered uneventfully. She needed more pain relief than is usual, but each patient is an individual and her whining seemed excessive, so she got drugs. It was just after lunch time (we do most of our surgeries in the morning) that one of her nurses noticed that Summit was less responsive to calling her name and her gum color was pale. She asked me to check her out. I noticed her abdomen seemed a bit larger and there was oozing from her incision. There had been oozing from her skin all through out her surgery, so this wasn't too surprising, but I didn't like that large abdomen. I took a fine needle and syringe and aspirated or pulled fluid from her belly. It was pure blood. Lots of it. The staff went into emergency mode.

The receptionist let the waiting appointments know what was happening. Our clients are terrific. Of course it was an imposition, but they actually said that if it was their pet it was happening to, the waiting in line vaccine appointment better be put on hold for them! The rest of the crew got Summit back onto the surgery table and I scrubbed and masked and gowned up again. She was under anesthesia in minutes. With a fresh line of sutures I just followed the dots and opened her back up. I was able to visualize a pool of fresh blood, so I had my nurses collect it rather than just suction it off. I didn't know at that time what kind of volume we were dealing with and what the cause of the loss was. I figured we could save the blood and give it right back to her in an autotransfusion; that's just what we did. We collected the blood with sterile syringes and put it into a transfusion bag, then administered it to her through her IV catheter after filtering it to be sure no blood clots passed through the line. That was significant-no blood clots in the collected blood. There was a clot around the uterine stump when I later explored her abdomen for the source of the bleeding, but no clots in the free blood. She had literally "oozed" all this blood rather than hemorrhaged from large vessels or slipped sutures. It was a mystery, a very serious mystery because without an obvious cause, we couldn't be sure she wouldn't do it again. Regardless, I put ligatures around everything I could, again, making triple ligatures in most places, suctioned her abdomen dry, watched for bleeding, couldn't find any, and closed her up. She was started on antibiotics and more pain medications. She got her blood and a fluid product called hetastarch, and she continued to get IV fluids as well. We monitored her temperature and blood pressure, as well as her gum color. Her owner elected to take her home to nurse her overnight, but brought her back to us this morning for us to reevaluate.

So, what could have gone wrong for Summit? I thought of a couple possibilities. Her owner said there was a condemned house across the street and rats were running around. Rat bait ingestion could cause her to bleed like that. We also had to consider a genetic cause-diseases like Von Willebrand's Disease cause bleeding disorders similar to hemophilia and are found in this breed of dog. We may never know the exact reason, but thankfully, today it looks like she is doing better. Her incision is still oozing a little of the bloody fluid, but her belly doesn't look look like it is filling and her gums are nice and pink. She is up and wagging her tail and eating all the treats we offer her. And MY blood pressure is back to normal.

Peace,
DrReneigh

Monday, December 8, 2008

Franky Got "Tutored" Today


Franky is a darling little weiner dog, in today to have a big lump taken off his back. It is probably just a cyst (we had drained it a few times to take some pressure off it, but this last time it was harder to do and it had grown a bit, so I really thought we should just get it off him once and for all.) He is a bit of an older guy, so his owners were understandably nervous about his anesthesia. They had been so concerned about it for so long that he never did get his much needed castration (neuter) surgery done. Then there was the matter of his dental hygiene. Franky hadn't likely used a tooth brush in a very long time, if ever. He had a lot of dental calculus build up, receding gums and some nasty halitosis. It seemed like a prime time to make good use of that anesthetic procedure and have all three procedure done. There is a risk, of course, to doing three procedures at one time-this extends the duration of the anesthesia, potentially dropping blood pressures and body temperatures. But with good monitoring and proper attention to those parameters, these risks become less of a concern as is a complete second or third anesthetic procedure. Remember, every patient is an individual, and after a thorough examination and pre-anesthetic blood work, we determined Franky healthy enough to tolerate the relatively lengthy procedure.

He came through like a champ. He'll have a scar where we removed the large lump on his back; we are sending that tissue to the lab to find out exactly what it is so we don't have to worry about it any more. His teeth are all cleaned up and some source of obvious pain and infection were removed, some broken and loose teeth hidden below the calculus and now he has nice fresh breath, too. I'll bet the removal of those sources of pain will improve his, at times not so friendly disposition. And now he won't have to worry about the babes any more.

I remember an old Gary Larson "Far Side" cartoon where a happy, goofy, and clueless dog was bragging to his pals that he was getting to go to the vet's to get "tutored." In a way, I guess it does make some dogs smarter. Brain surgery and all. Now, we shouldn't joke about this to poor Franky. He did great with all three of his procedures and didn't even drop his body temperature or blood pressure thanks to the good anesthesia monitoring and management of his nurses. His owners are on their way to pick him up and spoil him rotten tonight. He deserves it, as we all do.

Peace,
DrReneigh

Friday, December 5, 2008

What a "Sweet" Cat!


I didn't put "sweet" in quotes because I'm being sarcastic or I don't really believe it; with a blood sugar level of 570mg/dl (normal would be between 70 and 120) Cooper has diabetes mellitus.

Cooper actually came to us because he was walking funny according to his owner. His hind legs were sort of wobbly and he was very lethargic. Always a big cat, Cooper had been losing weight over the last year or so. Digging a little deeper into his history, we also found that he was PU/PD(polyuric/polydyspic)-drinking a lot of water, particularly demanding that the faucet was turned on for fresh water at all times.

Every one of these symptoms, even the "walking funny" can be symptoms of diabetes due to the excessive blood sugar levels. Cooper wasn't limping in his hind legs-he was showing a neuropathy or weakness here. Diabetic cats with these symptoms are usually fairly advanced in their diseases and most veterinarians do not believe that the weakness is a painful condition but rather a lack of sensation. I suppose that is the lesser of two evils.

In a diabetic (human or animal) there is not enough insulin to allow cells to receive glucose from the blood. The body is actually unable to detect the glucose in the blood and is fooled into thinking starvation is occurring. This is why protein, starch and fat start to breakdown, despite the fact that plenty of glucose has been there all along. But without the insulin, the "fuel" cannot get to the tissues that need it. A normal kidney can prevent glucose loss in urine. In diabetics, glucose overwhelms the kidneys and it spills into the urine. Glucose is able to draw water with it into the urine. This leads to excess urine production and excess thirst to keep up with the fluid loss (all that drinking and peeing.)

So, Cooper came back in this evening with his humans, ready to start the huge undertaking of managing his diabetes. He was dispensed a prescription diet of a high protein, low carbohydrate food. His owners were taught how to handle insulin and syringes and gave a few test injections to Twitchi, our Flake's Fund cat (who is still waiting for a home!) They were given lots of information on the disease and websites that have information they can trust (there is so much "hysterical" information out there on the web; it can be overwhelming when your pet gets a diagnosis like this.) Some sites for more info on diabetes in pets are:

www.felinediabetes.com
www.caninediabetes.org
www.sugarcats.com

We will schedule frequent rechecks of his blood glucose levels, and keep in touch with his owners on how they are handling his symptoms and his medications. We will make sure they know what kinds of things to watch for that indicate his blood glucose levels may be changing-so they don't inadvertently overdose him on insulin, and then what to do in case that happens. We have actually had many diabetic cats resolve their diabetes! It could happen with proper nutrition and insulin administration right from the start, so I let Cooper's owners know that was a remote possibility. We'll keep our fingers crossed for him. It is a crummy diagnosis, for sure, but he is lucky to have dedicated humans helping him through these initial tough times. He really is a "sweet" cat.

Peace,
DrReneigh

Thursday, December 4, 2008

Pablo's Aching Joints



When I was visiting my in-laws over the Thanksgiving holidays, I of course wanted to check over their way cool cat, Pablo. Both of Michael's parents are artists, so it has been a tradition in the family to have cats with artist names. One I fondly remember who resided at their art gallery and motel was a beautiful brown striped Norwegian Forest-type cat named Toulouse. She would often stay overnight with guests of the motel, and regulars would even call ahead to "reserve" her. She was a great cat.

Pablo is a sleek, black, very solid boy with some sprinkling of gray hairs and whiskers telling his age a bit. I noticed he was pointing his left front leg when standing still and was a bit hesitant to jump on and off the kitchen counter where he has access to a window that his mom props open for him. It looked like he had to take time to "plan" his jump; I thought he was reluctant because the action he had done multiple times a day for 10-plus years had taken its toll on his joints. Like I said, he is a very solid cat, and all that weight pounding on his joints over and over throughout his life now seemed to hurt him.

Pablo's mom had seen subtle signs of him "slowing down" recently; she had placed a stepping stool next to the counter so he didn't have as far to go in one leap. Now he could stage each jump into two smaller steps. She hadn't noticed the "pointing" of his front leg that I showed her-a symptom of some pain in his shoulder, and this was confirmed when I examined him. He was fine when I palpated his elbows and right shoulder, but REALLY objected to that left shoulder being flexed and extended. I didn't have my x-ray machine at hand, darn it, but I felt confident in my "rule-outs" for his condition. Pablo was likely suffering from osteoarthritis or degenerative joint disease.

We all know how "fun" it can be to medicate cats. It isn't just the physical action of getting a pill into a cat that makes medicating cats a challenge. The metabolism of a cat is different from other species and can be very sensitive to drugs we consider benign or safe. A single Tylenol, for example, can kill a cat. Their kidneys just can't handle many NSAIDs such as aspirin, at least when given at common intervals like we give humans or even dogs. Since I also didn't happen to bring my blood analyzing machine with me on vacation, Pablo's organ function was unknown to me. Fortunately, I had some experience with a product that might help him with out being harmful to his aging organs. It also comes in a formulation that actually tastes good to cats, too!
Cosequin is a nutritional supplement containing glucosamine, chondroitin and manganese-ingredients shown to support and maintain joint health. I love this particular formulation because it is a capsule that can be opened up-the powder inside is fish flavored. Our hospital cat, Noodles, actually chews up her capsule to get to the tasty powder inside!

I have quite a few of my older cat patients on nothing but Cosequin for their early "arthritis" symptoms, including Spencer, my sister Teresa's handsome companion. Some will eventually need more for pain management, and we will work on multi-modal analgesia (as we have discussed before) when that time comes. Weight loss and controlled exercise is just as important as it is in humans and dogs, but can be more difficult to implement (of course, we are talking about cats, after all!) Physical therapy and alternative treatments such as acupuncture have had varying success in cats, but it is often suprising how tolerant they can be of some of these things, even underwater treadmills and passive range-of-motion exercises.

When I got back to the hospital on Tuesday, I packed up a box of Cosequin and sent it off to Pablo. I hope he likes it and I hope it works to give him some relief from his apparent aching joints. If not, I'll make sure his mom gets him in to see their local veterinarian for some blood work and x-rays to see if it is safe (and appropriate) to get him started on an occasional "cat-friendly" NSAID such as Metacam (meloxicam.) Then again, maybe NOT jumping on kitchen counters is a good thing??? Nah.....

Peace,
DrReneigh

Wednesday, December 3, 2008

Poo-Poo


I mentioned that yesterday was a pretty busy day of life and death cases. The final appointment was no exception. I was expecting to do a check up on a long-time patient, Gypsy, an elderly cat with a very devoted owner who has faithfully treated her friend for heart disease for 4 years. In the hands of virtually any other owner, I had no doubt Gypsy wouldn't have survived a year, much less 4. She took her to the veterinary cardiologist periodically for ultrasound exams of her heart and fine tuning her numerous heart failure medications. But a few months ago another problem of older cats started becoming a problem for Gypsy-her kidneys started to fail. On top of the heart and blood pressure issues, she was now losing weight, vomiting, and just not eating more than licks of gravy off her canned foods. Always a tiny girl anyway, she was wasting away rapidly despite all of her owners best efforts. Gypsy's owner was concerned because she was crying a lot and acting ravenous, but just wouldn't eat. She was also acting like she couldn't see or was maybe confused or lost in her own familiar house. We had tested her for some issues that older cats get that can result in these symptoms-hyperthyroid cats often start to vocalize, especially at night. Cats with high blood pressure can often develop vision problems. Gypsy checked out fine on those tests. We tried confining her to a single room in the house, and even though she didn't like that much at first, we really think it helped her vocalizing and apparent confusion.

We were planning to test her blood to see where her kidney values were today. One look at Gypsy told us what the blood levels would be with out ever needing to draw a sample. She had lost another pound of body weight and now was only 4 pounds. She was breathing with rapid, shallow breaths-no doubt fluid was building up in her lungs. She still loved the company of her humans-on her terms. She is a cat, after all! But is was evident that she was tired and weak, a mere shadow of her former self. Her hair coat had some shine, but nothing like the luster of years gone by. Her eyes were a bit sunken in the sockets-she was dehydrated despite drinking well.

Gypsy's owner always did everything her doctors said should be done. She faithfully gave multiple medications every day, several times a day, all those years. She gave Gypsy special diets, took her to the specialists, she spent a huge part of her life and money taking care of this special family member. There was just no question to her that if it needed to be done, she would do it for Gypsy. What a lucky cat to be loved and card for so well!

Last night she was emotionally drained and crushed to learn of Gypsy's weight loss. She needed to hear from me that it wasn't just OK but that it was THE right time to let Gypsy give up the fight. Her relief was instant. She couldn't make the decision for Gypsy, but she had obviously spent oh so much time thinking and praying about it and just needed confirmation that her dear friend needed this one last gift from her.

Did you see the title of this blog? "Gypsy's" owner had a confession to make to me on this last visit with her. We had known her for years as Gypsy because her family was embarrassed to let other people know her real name-"Poo-Poo." This, her owner explained, was even a bit of a compromise because actually she started out as "Little Shit" when she was a crazy, frisky kitten so long ago. Her true personality sneaking out a bit.

I got the beautiful picture above and this bittersweet email this morning:

Good morning, Dr. Gray,
I wish I could stop crying. I miss her so much.
Thanks again for everything you do for God's animals. You're a blessing!
Here's the picture I promised.....

Although a passing is a sad, sad thing, we can truly celebrate the human-animal bond remembering this wonderful relationship. Don't all pets deserve this?

Peace,
DrReneigh