Thursday, February 26, 2009

Rub a Dub Dub, Tazzy in a Tub

No doubt about it, Tazzy needs a bath. She's looking a bit scruffy lately, and her skin is getting itchy. You may not realize that bathing a pet can be a medical procedure in some cases. Regardless, proper grooming is essential for the health and comfort of your furry friend, particularly the longer haired ones like Tazzy. Mats in the fur can twist all the way down to the skin and cause pinching and bruises. Owners who have tried to cut these out have inadvertently cut the skin when they used scissors in awkward places like armpits and behind ears. Dirt or urine and feces that soils the hair and skin can cause dermatitis or inflammation or infection of the skin, especially in skin folds or under the tail and between legs. Fleas are terrible little pests that certainly cause itching and allergies in a lot of animals. Dogs and cats can also get many of the same types of skin conditions that humans can, seborrhea or greasy skin, dry, flaky skin or dandruff, alopecia or hair loss. Even some metabolic issues like hypothyroidism and Cushing's disease can exhibit some skin problems.

There really are some important "how to's" when it comes to bathing a pet. First you need to understand the reason for bathing. Some may be healthy but just got dirty or rolled in something stinky. (Verbal just loves to do this! I think I mentioned once that the stinkier dogs are the most popular ones-they have a better story to tell when others come up to sniff them.) Long-haired critters frequently get things stuck in their fur, especially in the long hairs under their tail and along the back of their hind legs. Is the pet covered in fleas? Do they have a diagnosed skin infection or condition you need to treat topically with a medicated shampoo? Are they particularly itchy?

After answering those questions, you can choose the type of shampoo to use on your pet. Your veterinarian may have prescribed a medicated formula to use. There are many over the counter pet-friendly shampoos at pet stores, feed stores, even in grocery stores. Safety is particularly important if you are bathing a puppy or kitten. Be sure to avoid the types of "flea shampoos" that have pyrethrins as the active ingredient. 1 in 5 dogs and many more cats will have severe reactions such as tremors or seizures and some could die. We recommend simply using a regular shampoo and then using a safe flea product such as Frontline Plus after the pet is completely dried.

For a routine bath, it is nice to use a mild, soap-free shampoo with omega fatty acids. This will keep the pet's skin healthy and won't strip it of the essential oils needed to maintain healthy hair. There is also a lot less flaking and itching as a result. The omega fatty acids also make the topical flea product, Frontline Plus, work much more efficiently, so important knowing how expensive it can be!

The process of bathing isn't very complicated, but does require some work on your part. When using medicated shampoos remember-we are treating the skin, not the hair. If the pet's hair coat is particularly dirty, you should do a "pre-bath" with a general cleansing shampoo to remove the dirt. The second medicated shampoo will require much less of the more expensive medicated product. I like to dilute out the shampoo in a pitcher of water and pour this solution over the pet, allowing for a more even coverage over the body. Some medicated shampoos don't lather up very much, but do work them into the skin for 10 - 15 minutes (your veterinarian will have specific instructions) and then do a COOL water rinse. Warm water generally makes the skin tingly, and tingly skin can be itchy. Cool down the water if your pet is itchy. Be sure to rinse thoroughly-then rinse again! It is important not to leave any shampoo in the hair coat where it could rub against the skin, especially in the armpits or groin. There are some leave-in conditioners available, again some have essential fatty acids and/or antihistamines to relieve itching which can be worked into the skin after rinsing out the shampoo.

How often should you bathe your pet? Some cats never get a bath their entire lives and seem to do just fine. They are meticulous groomers-if they stop doing this it is time to visit the veterinarian. During the summer when Verbal gets to go to the lake, she'll get a quick bath every time due to the algae and duck poo found there. She develops "swimmer's itch," a type of skin infection if I get lax in giving her those baths after swimming. Sometimes she just needs a "de-stinking" bath, and Kristina, my hospital attendant, is wonderful at taking care of her. Medicated baths will have instructions for frequency and length of treatment, often multiple times a week at first.

Remember to thoroughly brush out the hair coat BEFORE you get it wet-matted hair will shrink up in the water and be virtually impossible to comb out afterward. Also, use an ear drying product in the ear canals after any bath. We can't get our fingers deep enough in the ear canals to dry them out manually, so the liquid cleaner/driers are essential to good ear health. Wet ears like to grow yeast organisms and infections result.

Tazzy is a different dog after her bath-she's white again! She got her nails trimmed and anal glands emptied as well as those ears cleaned out-a full spa day! Her owners will be very pleased and much more likely to cuddle with her now that she looks and smells so much better. That is, until she decides to find her own "perfume" to roll in.


Monday, February 23, 2009

Look What We Did for Lunch Today!

It is a little hard to see what (who) is piled up next to Dazzle, sleeping there with her good pain medications on board from her lunch time C-section. I don't have time to write right now, but I will tell you that momma Dazzle and 6 babes are doing great! It sure beats a sandwich any day!


Friday, February 20, 2009

No More Jumping

Our young dogs and cats sure are happy, bouncy things, aren't they? Some literally fly through the air, off couches, beds, in and out of their cars or trucks, so eager to join us wherever we are, whatever we are doing. But there comes a time, all too quickly, when those bouncy, flying bodies pay the toll for all that concussion over the years. Last year I decided it was time to admit this about Verbal, and decided to get a ramp to help her in and out of the little SUV we drive in to work every day. It is a bit higher than the truck we used to have, and I was noticing her hesitations and occasional misses when scrambling into the back. Of course coming out never looked like a problem, but with all her weight coming down on her shoulders and front legs like that, I knew it wouldn't be long before that, too, would cause her pain.

Training a dog to a ramp is important, especially in scardey dogs like Verbal. Starting with a quality ramp is essential-don't cut corners. You will be using it every day, sometimes numerous times every day, so you want it to last. More important is that the dog feels secure when walking or running up and down the structure-cheap, flimsy ones might collapse on them or scoot out from under them and re-establishing trust will be very difficult after such an accident. Many people are tempted to make something out of plywood or something-I know Michael wanted to! But trainers across the board warn against it. If it is sturdy enough to support your dog, it will likely be too bulky to use easily; consistant use is essential to get the benefits and instill that confidence in your dog. If it is too light weight it may not be safe or long-lasting.

There are numerous types and styles of ramps specifically designed for dogs-you can find them in pet stores, feed stores, even on line. I got a pretty good deal on eBay for a 3-fold one, not too heavy and it supports up to 400 pounds. It has a rough surface for good traction when Verbal's paws are wet and has a snap attachment for the bumper of the car so it won't slip and fall down while being used. It folds up and stores in the back of the car very easily, a bit of a pain at first but we are both used to it now and Verbal knows to wait while I unfold it before jumping in or out. It is a big game to her, and of course, there are cookies involved!

Since food is always the way to Verbal's heart, that was the best way to train her to the ramp. Other dogs might be clicker trained, work for praise or toys. We started by just having the ramp unfolded in the house for her to sniff and get used to seeing for a few days-no big deal. Then we put her food and water dishes on the ramp when it was open flat on the floor. She got used to stepping on the textured surface-again, no big deal. We then graduated to practicing on a very gradual incline on the deck where there is just two steps elevation. We picked one direction to work on at first, walking down the ramp. Dog's do better learning one new trick at a time, so consider up and down two seperate "tricks." Their minds and their muscles will get in better shape this way. I figured jumping down would potentially cause greater harm in the long run, so chose to teach her the down direction first. I loaded up my pockets with treats, and away we went.

I put her at the top of the ramp, told her to wait, showed her the cookie, pointed to the ramp and said the word "ramp" simultaneously. I led her down the ramp with the cookie bribes in front of her. Don't just tease with the treats-keep feeding them or rewarding them and keep the dog totally focused on those treats, not the ramp. It is important NOT to use the dog's collar or harness to pull or guide them when they are learning how to use a ramp, even though it is very tempting to do this. Do use a leash and be prepared to support their whole body if they are unsteady or look like they are going to jump off the side of the ramp. Verbal gets excited and likes to jump off half way down lots of times-no cookies when she does this! Don't let them cheat like she does, and do be consistant-even if you are in a hurry it is important to always use the ramp. You can use the same techniques for teaching the opposite direction, for increasing elevations, and for teaching dogs who are using ramps for getting on and off couches and beds, not just in and out of crs or trucks.

Treats or whatever you deemed is the reward for your dog helps establish the habit, but you won't have to use them forever. I do keep a box of diet treats in the back of my truck right next to the ramp, but by now Verbal will do the ramp with or without treats. She is so proud of herself when she runs up and down that thing! Some dogs may need a running or trotting start to use the ramp, so be sure they have room to get started. When dropping the ramp down from a bed or couch, you might find it easier to position it alongside of it rather than straight out from it. It will afford better stability and security for your dog.

After one direction is going well, teach the other one. You really don't need two seperate commands- (up or down) "ramp" works fine either way. The dog will already be at the top or bottom so will know which direction he or she needs to go.

The best time to train your dog to use a ramp is before they really need one-before they are hurting or lame. That way there is no pain associated with the training situation. If your dog does have arthritis or other aches and pains already, as is usually the case, be sure you work with your veterinarian to have good pain management before you attempt this new training. Your dog will thank you! And likely your back will, too, if you are like me and were starting to do a lot of lifting of your dog in and out of the car. No fun, especially when Verbal was wet or muddy. A ramp can be terrific for our once flying friends who just need a little help to make their lives easier. Life is too often hard, so I'm all for things that make it easier!


Thursday, February 19, 2009

In or Out?

We see quite a variety of cat patients at our hospital every day. Not only different breeds and colors, male, female, big and bigger, (Spartacus and his "ample intra-abdominal fat") scardey cats and those who bump heads and purr so loudly I can't even hear their hearts during their exams. Another difference has to do with where these kitties spend their days-are they indoor or outdoor cats?

If you ask most veterinarians, I'm certain you would find we believe that indoor cats are much longer lived, especially in our suburban area. Obvious sources of doom are fast cars, as well as coyotes and other predators. More insidious are the free-roaming, non-vaccinated cats that can spread deadly diseases to our beloved friends. I think the worst would be the case of the cat that doesn't come home one day, never to be seen again. How your heart would ache, never knowing the fate of your pet, possibly injured, scared, or worse. Life span estimates have been made as dramatic as 3 years for outdoor cats compared to 12 to 14 for their indoor counterparts.

Being an indoor cat isn't without its risk, however. Because of this possibly more sedentary life style, we can create health issues every bit as serious as those seen in outdoor cats. Obesity is definitely on the rise, and with it, the wear and tear on joints as cats jump down from high cat perches or off beds and couches over the years. Diabetes, too, is more often seen in the indoor, fat cat, so proper nutrition and exercise is essential to ward this off.

Behavioral problems sometimes result from the "unnatural" confinement of indoor cats. Simple boredom may result in apparent compulsive disorders. We can see redirected aggression when indoor cats see other cats outside, don't like it, feel threatened or angry and don't have a release for their emotions. They may turn those emotions on other household cats or even their owners, sometimes quite unexpectedly and very dangerously. Litter box problems can occur, and may be a result of behavior or medical problems, often difficult to tell the difference without an examination and urinalysis testing by your veterinarian.

Sometimes we ask multiple cats to get along with each other in a close space when maybe one or more of those individuals might have preferred a single life style. Many can adapt over time, but I have seen quite a few that develop self-mutilation behaviors or chronic urinary tract problems, apparently from the stress of situations like these. Re-homing a beloved pet may seem drastic but may be in the best interest of a very stressed cat.

I mentioned before that boredom and inactivity may predispose indoor cats to problems. There is a group of veterinarians and interested cat professionals that developed "The Indoor Cat Initiative" to make cat owners aware of these issues. Their website is terrific, offering information and resources for help with the unique problems of indoor kitties. I particularly like the information about cat's natural habits and tendencies to consider when making your home suitable for your pet. Hunting prey is important to cats, so toys that mimic little birds or mice might be preferred to the shiny ball-type toys, but every cat is different. Our hospital cat, Twitchi, LOVES pens and pencils! At the beginning of the day we have to go through her kennel and find all the lost ones she has squirreled away in her cage during her nightly hunts. She cracks me up. My cats at home like the little plastic rings that come off the milk jugs. There must be a hundred of them under the refrigerator!

The keys to enjoying cats in our lives is to provide acceptable outlets for their natural behaviors and to reduce their exposure to threats. No matter where your cat spends most of his or her time, keeping the barn free from mice or sleeping in the sunshine high on a cat perch, it is important to be aware of the health and behavioral issues they can face. I think you can do that both ways, but be sure your veterinarian knows how your cat lives so they can help you with his or her unique needs. Maybe your indoor cat can avoid the diet Spartacus just had to start, the poor starving thing.


Wednesday, February 18, 2009

When Organs Go Bad

Hi all, Remember me? I haven't been able to blog for quite awhile-we have been busy at the hospital and extra-curricular "stuff" has just left me tired and uninspired for writing. I hope those times are behind me now!

We had a very sick patient the past couple of days that everyone on the staff worked very hard for. Jericho was a sweet, older dog who could barely walk in to the hospital yesterday-he was just way too weak and disoriented. He was constantly vomiting and had severe vomiting. Worst of all, these symptoms had likely been going on for 10 or more days with no treatment! He was beginning to show signs something was wrong almost 2 weeks ago, but then the owners had to leave town for vacation. Their dog sitter didn't provide any care for Jericho while they were gone, so he just continued vomiting, not eating, and got weaker and weaker. The dog we saw just wasn't the same dog they knew and loved.

Of course we wanted to know if he could have gotten into anything, eaten poisonous plants, swallowed a rock or bone or some other foreign object, causing an obstruction in his GI system and thus the signs we were seeing. Other possibilities were eating a toxin of some kind, antifreeze for instance, or being fed a poison by a disgruntled neighbor. You hate to think that way, but it sure can happen. He was an older dog but not geriatric, so we didn't really think organ failure was high on the list of rule-outs, but we put them on the list any way-kidney and liver insufficiency, pancreatitis, enteritis. Jericho was not current on his vaccinations, so parvovirus was possible. No matter the cause, this boy was SICK. He was dehydrated from the loss of so much fluids and inability to keep anything down, and the weakness and disorientation could have been from electrolyte imbalances or toxin build up in his blood stream. His prognosis or ability to recover from this problem wouldn't be able to be determined until we identified a cause.

We gave Jericho's worried owner a treatment/diagnosis plan, starting with a parvo test-it was negative, thank goodness. We then did a complete blood count and general blood profile and there we learned the source of his symptoms. Blood Urea Nitrogen or BUN and creatinine are two blood values that are normal by-products of metabolism and excreted by the kidneys. Our "normal" values for BUN are 7 - 27 mg/dl-Jericho's value was over 130! It was so elevated that the machine couldn't give an accurate value. The creatinine was similarly increased. The two values being elevated together is called azotemia-a strong indication that Jericho's kidneys had failed. The other major problem was the phosphorous level, a product usually eliminated from what we eat, again by the kidneys. When they aren't functioning, it becomes elevated and makes the patient weak and ataxic or wobbly, just like Jericho was. His phosphorous level was sky high.

Jericho's owners couldn't think of anything he could have gotten into that could have caused this to happen. They said they have good neighbors that love dogs-very unlikely to poison him. There are some diseases like leptospirosis as we have discussed in the past that can cause kidneys to fail. Of course, being an outdoor dog, he could easily have found something bad to eat, so we may never know what did this to him. The most important thing was-could he recover?

The answer to that question is never easy. Dogs are individuals, and sometimes those with very severe symptoms and lab values recover uneventfully and go on to live long lives. Some with minor changes will suddenly worsen and die despite aggressive treatment. Only time and treatment will tell. Often that means spending a lot of money, unfortunately without a guarantee of success. I felt Jericho's chances to survive were very poor, but his owners felt they owed him at least a chance. Our whole team came together for him and initiated an aggressive treatment plan. We sent in an ethelyne glycol test. This would tell us if he had been exposed to antifreeze or not. If he had, his chances would be next to zero and I told his owner this. In the mean time, we placed an IV catheter to administer fluids, gave him pain relief medications, anti-vomiting medications, and antacid medications-all by injection as he wasn't keeping anything down orally. He was so much more comfortable right away-just taking away the pain and vomiting reflexes was enough to allow him to sleep comfortably and allow his body to start to heal-or so we had hoped.

Jericho received IV fluids and medications throughout the day. We aren't a 24 hour hospital, so we could have sent him to one for round the clock observation if I had thought he needed that. His pain level seemed OK, his fluids were running well and all he was doing was sleeping so I thought he would be fine. I offered to check on him later that night and his owner agreed that should be fine. Around 10:30pm he was QAR (remember our abbreviations?-quiet, alert, responsive), he walked very slowly outside to urinate, but I had to carry him back in. He just got tuckered out. He hadn't vomited but his heart rate had increased and his pupils were dilated so I thought his pain level might be rising. I gave him another dose of a narcotic and made sure he was toasty warm and that his fluids were running well.

This morning Jericho was again QAR. The ethylene glycol test came back negative. I was considering running a test for leptospirosis, an infectious cause of kidney damage, and would discuss that with his owners later. We again gave him pain meds and some anti-vomiting medication as he had started to lick his lips and drool a bit. Today, though, his drool was quite bloody-I was very worried about gastritis from the uremia that had developed from the kidney failure. His owner came to visit him and spent about half an hour with him. He seemed to perk up a bit while she was here which was good for both of them. Literally a few minutes after she left, Jericho stopped breathing. The nurses called me back to see him, but it was usesless. He had made the decision about whether or not to fight this horrible disease. At least we know he wasn't in pain and his owner and he got to spend some nice time together right at the end.

I feel so bad for the family-I know they will hurt over Jericho's loss for a long time to come. It was great, though-his younger owner came right back into the hospital holding on tightly to a very scared brown tabby cat she had seen running wild behind the strip mall where our hospital is. She was worried the cat was lost, not eating, and possibly reproducing out there on her own. We scanned the kitty for a microchip-none was found. We will notify her if anyone calls missing their cat and she will foster it until then. This kitty is redirecting some of her grief energy into something more positive. Animal lovers through and through. Rest in peace, Jericho.


Tuesday, February 10, 2009

One More Abbreviation

Yesterday I briefly mentioned a disease with yet another abbreviation-FIP. No, I don't think Spartacus has this, thank God. He is doing MUCH better today, back to being his normal bratty self. FIP cats don't get better. They all die. It is a horrible, horrible disease that attacks cats in the prime of their lives, usually the young, healthiest ones of the bunch-so devestating. There is no effective prevention for the disease, no way to accurately diagnose it, and like I said, no cure for it; no treatments have yet been found to be effective against the virus that causes the disease.

FIP stands for Feline Infectious Peritonitis. It is caused by a mutation of a Corona virus that is so common over 80% of all cats have been exposed. So far, the mutation that causes the fatal form of the disease is much less common. It does seem to be more common in stressful situations for young cats, although any cat has the potential for mutating the virus. Catteries, pet stores, and shelters are all reservoirs for the virus as well as stressful, crowded situations that can lead to the mutation that causes FIP. I have seen FIP in single cat households, however. Lenny was my scruffy tabby cat that died of this terrible disese when he was just 18 months old-far too young to have been taken, as is quite typical of FIP. Owners often feel ripped off, having their friends stolen from them before they get to experience life, really.

FIP comes in two forms often known as dry (or granulomataous) and wet (or effusive.) There can be a large accumulation of a yellow fluid in the chest or abdominal cavities which causes obvious discomfort and/or pyogranulomatous lesions throughout all of the organs of a cat's body, which slowly shuts down their function. High fevers non-responsive to antibiotics is a common trait. Corticosteroids like prednisone, often given many times a day, can sometimes bring these fevers down enough to make the cats want to eat a little. Often the stresses of medicating that frequently just becomes too much for the pet and the owners. One of the really frustrating things about this disease (there are so many!) is the difficulty in difinitively diagnosing it. We actually find ourselves ruling out all other causes of the symptoms we are seeing-hoping there is a cause that has a potential for treatment. The accumulations of the fluid, the high fevers, elevations in proteins in the blood, particularly gamma globulins, sometimes a jaundiced or yellow appearance to the mucous membranes-any of these could have other causes but taken together usually do add up to the dreaded FIP diagnosis.

Lenny was a great cat. He was Stella's first nemesis-they grew up together and he was such a pain! We named him after the wise-cracking Lenny Brisco, the detective from Law and Order. When he stopped eating, stopped pestering his sister, then got the tell-tale distended abdomen full of yellow fluid, my heart broke. It was really just a matter of days before he became too uncomfortable and we had to say goodbye-he was curled in his cushy bed at home and I believe we made it as peaceful as possible. I did a lot of cursing about that damned virus, though. It is so unfair.

Cancer and organ failures and other diseases of older animals are terrible, for sure. But sometimes we can understand and accept them a little easier knowing our pets had good, full lives when that diagnosis comes at 14 or 15 years old or so. We are still very sad, of course, but so thankful for all the years of good memories. Diseases like FIP are just thieves-they steal life from us, literally. Hopefully research will continue to help us learn how to recognize FIP-to fight it, and maybe even prevent it someday. Rest in peace, Lenny. And keep on getting better, Spartacus. You sure had me scared!


Monday, February 9, 2009

Spartacus Ain't Doin' Right

Medical professionals like veterinarians and physicians write a lot of records. Some are now going to a paperless system, putting all those records on computers, but still, the information has to get transcribed somehow. In the hopes of speeding things along, we use quite a few abbreviations and acronyms, some are common and used universally but others are pretty specific to the profession at hand.

Some of the more common abbreviations have to do with medication administration. Identifying the route of how a medication is to be delivered is very important, so we aren't as likely to use these abbreviations for owners. I once had an owner put the powder from the capsules dispensed for an ear infection IN the ear of her dog. Of course they were supposed to have been give orally and it resulted in quite a mess that didn't do the infection any good at all for the poor dog. The origins of the abbreviations are usually from their latin words, such as that for the oral route: PO, or "per os." You are probably familiar with routes such as IV for intravenous and IM for intramuscular as well as SC or SQ for subcutaneous. There are many others. The timing of the medications can be specified by abbreviations such as BID-every twelve hours. It is important not to just say twice a day because that can be misinterpreted as 2 at once, two in the same hour-you just never know. Tid is every 8 hours, QID is 6 and so on. You can see why we abbreviate long words like subcutaneous.

Some of the abbreviations that I might use on a medical record might describe what a patient looks like, their vital signs. BAR is a description "Bright, Alert, Responsive." The patient might also be described as QAR, "quiet, alert, responsive." PU/PD means a patient is polyuric (urinating a lot) and polydyspic (drinking a lot.) Getting a TPR on a pet is a first step in their physical exam-temperature, pulse and respiration. HR=Heart rate, RR=Respiratory rate. MM=Mucous membranes, CRT=capillary refill time. V/D is usually vomiting/diarrhea, C/S is coughing/sneezing. Veterinary specific abbreviations can describe what brought the patient in to the hospital in the first place. BBBD is "Bit By Big Dog" or sometimes BD/LD = Big Dog/Little Dog. I like PPQ: Porcupine Quills. HBC = Hit By Car. GDV is gastric dilitation and volvulus. FLUTD is more of a diagnosis-feline lower urinary tract disease; again, see why we abbreviate? That is a mouthful!

DIC is a condition called disseminated intravascular coagulation, so serious and often fatal that doctors often nickname it "Death Is Coming." I know of a few others that we don't put into official medical records (well, maybe Dr. House from TV would!) but that every medical student knows: CTD turns out to be "Circling The Drain" and TTJ is "Transferred to Jesus." It is nice to be able to interpret lab results as WNL- "within normal limits" or NSF-"no significant findings."

Over the weekend my own cat, Spartacus, gave me quite a scare. I described him as ADR-"Ain't Doin' Right." It certainly isn't an "official" diagnosis-I hadn't even taken a temperature on him at that point!-but he looked awful. He moped around, wouldn't eat anything-not even his beloved shrimp that he usually bugs me and Michael for. Now THAT had me worried. He didn't get as fat as he is without loving his food. He hid under our bed, not having the energy to displace Stella from the tall cat post. There were no fights between the two of them-very unusual. He seemed grumpy about me palpating his belly, but that was not unusual for him. He certainly doesn't like to be messed with. There are a ton of reasons a cat could be sick and not feeling well, but we had a big scruffy tabby cat like Sparty several years ago named Lenny who died of an awful disease called FIP. He looked just like Sparatucus did and boy, did he have me paranoid. I needed to know what was going on, but I didn't want to all at the same time. That is probably why human physicians aren't allowed to treat their own children. I had some antibiotics in my doctor's bag at home, so started him on those (that went over well-not!) and pretty much left him alone.

Last night he started to eat a bit-I was so relieved! Michael said he caught him sleeping on the big cat post and I ran to the freezer and got a giant shrimp for him. I defrosted it and he at least nibbled on most of it. The pain of getting those pills in that brat of a cat was worth it. I think he is going to be just fine, but I brought him in to the hospital with me today, anyway. He isn't too happy with me but that's just tough. We got some blood and urine samples and took some x-rays. He did much better after getting some narcotic pain medication (I had only given him an NSAID at home; oh great, I have a junkie for a cat! I can tell you the few days of not eating didn't do much to reduce the fat stores in his body-the radiologist will certainly scold me for the excess intra-abdominal fat-so he is going on a healthy diet when he gets better. He's already eating a diet formula cat food-he must be eating an awful lot of it! Oh well, I'll keep you updated on how he's doing. Some times it's our naughtiest "children" that we love so much....

His blood work just came back and it is perfectly normal, of course. He's getting his antibiotics PO, BID and I'll probably continue his pain medications and give him some fluids SQ. I'm hoping to change his ADR status to BAR real soon. I can't think of any abbreviations to sum this all up. How about X and O? Hugs and kisses?


Friday, February 6, 2009

Maybe We Will Try Rogaine....

One thing I envy about people who don't have lots of animals in their lives is their immaculate homes. No couches scratched by the cats, no clogged vacuums full of hair. Ok, I don't really envy them that much. Even a mansion wouldn't be worth it to me if I couldn't share it with my furry family members. Shoot, I don't vacuum enough for it to get clogged, anyway!

Speaking of hair, our veterinary hospital sees a LOT of it every day. It is not uncommon for stressed animals (and unfortunately sometimes a trip to a veterinarian's office is a stressful event) to shed dramatically. We have to sweep, vacuum and/or mop after each patient in an exam room. I know owners are worried their pets will go bald when they first experience this sudden shedding phenomenon. I read a theory that makes sense to me: adrenaline allows the release of the hair shaft root from the follicle so that when a predator takes a big bite of the prey animal, it is more likely to just get a mouthful of hair that is easily released and the prey can run safely away, maybe less a patch of hair, but at least without being eaten!

It is very common for patients to have an appointment because of hair loss issues-even before they experience the "stress" response due to the actual visit. Today a lovely girl named Maya came in for just that reason. Her hair loss had been going on for about a month-with no slow down in sight. She had a thick, black hair coat and her concerned owner hated the idea of her losing it. She had gone through a similar episode last fall where we treated her skin symptomatically; we treated the itching and hair loss but never did much in the way of diagnostics so never did find out what the underlying cause was. Thus her return today with seemingly identical symptoms.

When a pet presents with similar symptoms as a prior episode, it can be very tempting to just go ahead and treat them with the same medications and be done with them, especially if the owners were satisfied with the results the last time. Just refilling medications or getting a "shot" or other treatment and not messing around with lots of expensive and time consuming tests sounds like a good plan. It really isn't in the best interests of the pet, though. They will often be right back in with the same problem, over and over again-it can be very frustrating and might ultimately be dangerous if medications chosen aren't particularly safe when given repeatedly without proper monitoring. Corticosteroids like prednisone are one example of this type of treatment. It often results in instant relief from pruritis (itching) but long term use can result in liver problems, gi ulceration, diabetes, iatrogenic (medically-caused) Cushing's disease, or more. We certainly did not want this for Maya.

We began with our "rule-out" list. Just what are the most likely causes of hair loss is a patient with Maya's signalment? (a dog of her age, breed, size, sex and with the specific distribution of "lesions" on her body.) She really didn't display sores or lesions, rather just a diffuse or generalized hairloss. It did appear to be coming out by the root, easily epilating or coming free from the skin, not breaking in half mid shaft as damaged hair would. I didn't find any lives fleas or ticks, nor evidence of flea "dirt" or feces. Her ears seemed fine. Her hair wasn't exactly dull and her skin wasn't flakey or exhibiting dandruff. Neither was the skin greasy or malodorous. Maya wasn't an overall fat dog, either. Still, metabolic problems like hypothyroidism were a possibility. Labs are on the list as commonly affected by allergic skin and ear disease, either due to foods or atopy (inhalent allergens.) This had happened before in the fall so a seasonal problem wasn't likely-dry winter skin isn't uncommon. Her diet wasn't particularly good, kind of a junk food brand, so that might be contributing. Her owner didn't mention using a new shampoo or washing her bedding with fabric softeners that she might be sensitive to. You really have to act a little like Sherlock Holmes when trying to uncover causes for some of these problems in veterinary patients!

I joked a bit about trying Rogaine on her for her hair loss. While it isn't exactly "male-pattern baldness," some breeds like dacshunds are susceptible to pattern hair losses, but no one uses minoxidil for them as far as I know. We will start by running some blood work on Maya and being sure she is healthy overall. The stress of an illness could be a cause for this hair loss. We started her on some omega fatty acids (flax seed oil) that her owner has at home and she will gradually start a new diet. We will try some antihistamines for the itching and maybe some topical shampoo therapy-oatmeal can be "naturally" soothing for many pets. Daily brushing will help stimulate the natural oil production in her skin, creating a healthier environment for hair. We'll make some furthur recommendations when we get her blood work results back. Maya is well on her way to having a full head, err, body of hair again. I doubt she will go bald anytime soon.


Thursday, February 5, 2009

I'm Hungry!

It has always seemed funny to me. For the most part, clients take to heart advice given by their veterinarian- medications when needed, preventive dental care, exercise, even those silly satellite dishes (e-collars) around their heads to prevent pets from chewing out sutures or licking wounds preventing them from healing. But when it comes to discussions about what to feed pets, I often fight an uphill battle.

I suppose it is the impression that as a hospital owner I am making a profit by selling a recommended diet. This is rarely the case if I am recommending a maintenance or regular day-to-day diet for a healthy animal. We just don't carry them at our hospital, choosing to stock only prescription foods that we utilize as we do other medications-for a specific disease state or chronic condition. Even then, the mark up or profit on food is very small; it costs a lot to have food for rare diseases sit on our shelf waiting for that one pet that might need it in the future. We carry prescription foods because I really believe in their importance as a treatment for certain conditions and having them here is a convenience for our clients.

Owners often get advice for what to feed their pets from anyone BUT their veterinarians. They might listen politely to recommendations given by their doctor or nurse at the first puppy visit, even take the sample bag of food offered-then go to the pet store and buy something completely different. Information from pet or feed store employees (with no more training in nutrition than other high school kids) is often viewed as unbiased when the opposite is often true. Food companies offer incentives to stores to sell their brands or to display their bags or cans in prominent places. Contests, gift cards, even trips have been earned by eager sales people.

Of course people will also listen to friends and family members when seeking nutritional information for animals. If one particular brand worked wonders for Aunt Emma's prize Golden Retrievers for generations, how can you go wrong? Now a days, "Dr. Google" is getting a lot of credence, complete strangers "met" in chat rooms or elsewhere online always have advice and are eager to share experiences. There is no guarantee of veterinary nutritional training at all. People like to tell about the "evils" of ingredients such as "preservatives." Well, give me a break! If a food is not preserved, it will go rancid very quickly. More natural preservatives are available, but a food HAS to be preserved. The internet is full of these kind of stories, and some are down right dangerous. I met a cat once that had been fed according to one online "expert." She became a vegetarian just like her owners. Cats are obligate carnivores-they require animal protein sources in their diets for at least one essential amino acid, taurine, which is responsible for heart health and eyesight. This poor cat was completely blind. So tragic. And so preventable-this diet preference could have just been discussed with their veterinarian before hand and maybe supplements could have been given to prevent this tragedy.

Breeders are also the source of irrefutable information in the eyes of many pet owners. Veterinarians try to use the argument that a breeder's purpose is to get you to buy a single animal (often at pretty high prices!) while a veterinarian's purpose is to work with you to keep all of your pets healthy for a lifetime. Which one do you think is more likely to have your best interest in mind? I know that there are exceptions and that there are unethical veterinarians out there, too. (I hope they are few and far between.) But the following is my simple guideline for how to pick a healthy food for your pet-and no food company is paying me to tell you this!

First, a food line should have different formulas for the various life stages of a pet's life as well as sizes. We know the nutritional needs of feeding a Great Dane puppy are vastly different from feeding a geriatric or senior Chihuahua, for example. A puppy, kitten, or "growth" food, adult or "maintenance" diet,and a senior or older pet formula are basic. I also require "large breed" vs. "small breed" differentiations for dog foods, particularly in the growth or puppy stages. "Light" or lower calorie diets are very useful; "indoor cat" formulas are essentially light foods.

Second, foods should have been tested by animals to ensure their adequacy for the life stage recommended. There really is no enforceable regulatory agency for pet foods as there is with human foods (FDA.) The American Association of Feed Control Officials (AAFCO) statement is printed on each bag of food, stating that the food has met certain minimum requirements. But I believe that only the companies that actually feed their foods to animals and then test those animals for any side effects or metabolic problems are actually proving that they are good foods. These companies spend a great deal of money doing these feeding trials, and the animals have the best jobs" ever-eating food! It isn't like putting mascara in a rabbit's eye for Pete's sake. You will see the specific AAFCO statement that includes "Animal feeding trials substantiate...." when a company makes this commitment to your pet's food.

Finally, the food should be well-tolerated by your individual pet. Does your pet thrive while on it? Does he or she have solid, regular stools? Are they excessively gassy? Is the hair coat slick and shiny or do they shed excessively? Do they eat ravenously but still lose weight? These are all signs to help you asses that particular food. Remember, each pet is an individual and just because ALL other dogs of your breed (of course I am exaggerating...) do well on one type of food doesn't necessarily mean yours will, too.

Now, what do I feed MY pets? I have a "special needs" dog as you know. Verbal has terrible joint issues-hip and elbow dysplasia, degenerative joint disease from an injured cruciate ligament, her bouts of cancer, etc. When she was getting her radiation treatments 2 years ago, she got n/d, appropriate for neoplasia or cancer. Now she gets j/d, a prescription diet appropriate for joint health that decreases the need for me to give a bunch of supplements. My cats get one called w/d appropriate for weight control but also balanced so urinary calculi (stones) are less likely to form in Stella's bladder. She had an issue with re-occuring blood in the urine and that has been resolved with her diet.

One other thing: We often see owners giving supplements when the pets are already on balanced diets. This negates the job done by the nutritionists and actually unbalances the important ratios of some of the minerals and vitamins. I particularly see a problem with this during the all important growing phase in young large breed dogs. Ratios of calcium and phosphorous, for example, not the actual quantities of them, have been found to be most important for proper bone and tendon growth. This is also important for expectant or nursing mothers. What could be harmful about giving anti-oxidants, the ever-popular fish oils and the like-to your pet? Well, when Verbal was being treated for cancer, I was told by the veterinary oncologist that these would negate the effects of the radiation to some degree. We actually WANT to oxidize the bad cancer cells during this process, so anti-oxidants are a bad idea in this case. Whether or not to give a supplement, no matter how benign or seemingly beneficial, should be discussed with your veterinarian.

There are a lot of sites available that I do trust for good information on diets for pets. This page lists a lot of good ones. Nutrition Sites Some you need to register for, others are fee for service. Many are run through schools of veterinary medicine. Regardless, these are sites that have science behind them; you can trust the information supplied here.

There is so much more to nutrition than what we have talked about today. Treats, feeding "human food," diets for specific diseases, feeding raw diets, formulating your own foods for your pets, food allergies and sensitivities- we will likely cover some of these topics down the line. Let me know if you have any questions or topics in which you are specifically interested. All this talk about food has made me hungry. I think I'll go have a snack.


Wednesday, February 4, 2009

When You Need to Show Your ID

I was reading a report about a tragic accident that resulted in the death of a small kitten after a microchip was implanted in her. It sounds like the kitten was extra wiggly, she jumped or something and the microchip somehow ended up inside her spinal column. What a terrible fluke-you couldn't hit that area if you tried. This happened quite awhile ago; so many microchips have been implanted before and since, making me hopeful that the incident won't discourage people from having their pets chipped.

Permanent identification for pets isn't a new idea. Collars and tags just don't reliably stay on pets and can be removed easily by anyone intending to steal an animal. Skin tattoos were once very popular, particularly among pedigreed dogs, but because of the availability of microchips and the difficulty of tampering with them, tattoos aren't seen much anymore. Besides, it took special training to "read" tattoos, so their use for getting lost animals back to original owners was very limited. In the livestock industry, tattoos and plastic and metal ear tags are used routinely for fairly permanent identification of individual animals. These can be simple numbers for ID or proof of vaccination, testing, etc. The tags can get lost, rubbed off, etc., but are still the standard. Pig or hog producers use ear notching, actually cutting small wedges of tissue from the margins of the pinna (ear flaps) to identify birth dates, sire or dam, and other information important to the producer or farm. We may do something similar in feral cats when they are trapped, spayed or neutered, vaccinated and then released again-basically unadoptable "wild" cats. The ear-cropping will serve as a sign that this cat has already been dealt with if it is ever trapped again, but we really don't use this method in our "owned" pets for obvious reasons.

Microchips really gained popularity in the 90's, and millions of pets have been permanently identified this way. I even have my horse, Raquel and my donkey, Jesse microchipped! People often chip their large, valuable birds. The two largest companies, AVID and Home Again, get thousands of calls a day to track down lost pets. The chip itself is not a part of a GPS system-it doesn't tell us the pet's location. At approximately the size of a grain of rice, it basically holds a number, like a bar code, and sometimes the manufacturer information. Not all microchips can be "read" by other company's readers, a huge problem when owners assume their pets are protected, only to find, hopefully before the time it is needed, that their pet's chip isn't universally readable. When I know a pet has a microchip, I like to do a quick scan at the annual exam to ensure it is still in place and is reading just fine with our "universal" reader. Even being universal, we know there are some chips, particularly those implanted in Europe, that we can't pick up with it and we recommend that the pet gets another chip placed. Most shelters have true universal readers.

If a "good Samaratin" brings in an animal they have found, the first thing we do is scan it for a microchip. In dogs and cats, chips are universally implanted on the back of the neck under the skin. Chips have been known to migrate somewhat, so we scan in an arc over the front end of the pet-up one front leg, across the shoulders, and down the other front leg. We assume those checking animals at shelters are just as careful and thorough. If a number is found, we check our system to see if we sold the chip. If it isn't one of ours, we identify the manufacturer and call them. Owners who have their pet implanted are supposed to register the number with the company directly so they can now be identified and contacted. This step does get missed frequently, though. There is still a good chance of finding the owner, however. The manufacturer can tell us who sold that particular microchip, usually a veterinarian, breeder or pet store. A call to them will then identify who owned the pet at the time of the chip placement. If the pet was sold or given away after that, or if the owner has moved or changed contact information and not kept it current, finding them gets a bit trickier, (but at least it is a start.)

Most veterinarians have numerous stories of reunited lost pets with frantic owners, and microchips are a huge reason these stories end up having happy endings a lot of the time. They are simple to administer, kind of like getting a vaccination but with a bigger needle. Yes, it hurts a bit, and we like to do them when a pet is asleep for their spay or neuter, but there is no reason it can't be done awake. If your pet has never been chipped, get it done right away. Don't wait for the worst to happen and only think about this when your pet goes missing. If they have been chipped, are you sure you have the number registered with the manufacturer? Be sure your contact information is current-it doesn't usually cost anything to update information when you move or if you sell or give away a pet. Registration or enrollment is for the lifetime of a pet. Next time your pet is at the veterinarian's for a visit, have them scanned to check the placement of the chip-just to be sure.

Here are the web pages of the two most common providers:



Hopefully you will never experience the fear that comes from being separated from your pet. Not knowing if they are sick or injured, running scared, lost, unable to get back home to you for whatever reason. Microchips aren't the perfect answer, but they sure go a long way to providing some measure of assurance you are doing the best you can for your pet's safety. OK, Maybe no one will want to steal my donkey, Jesse-he really is an ass!-but he is chipped just like the rest of my critters and that makes me feel better.


Tuesday, February 3, 2009

Want to Watch a Spay?

As far as I know, no one has called or stopped by asking about her, so I guess it is safe to spill the beans. Remember Sunshine, the poor Basset Hound that was tied up to our picnic bench one afternoon, no note or ID tags-nothing? The dog that got my blood boiling about loser humans... Well, she is doing just fine-more than fine, actually. She is going to have one terrific life now, thanks to Chance and Phoebe's owners, two other Basset friends of ours. Of course we thought of them when we met Sunshine-they are some of the best humans we know, going above and beyond in their care for their furry family members, especially their "special needs" children. When we called to see if they could foster this abandoned dog while we decided what to do about her, they didn't even hesitate, saying of course, and instantly offering to adopt her before they even met her! Of course we wanted it to be OK with Chance and Phoebe, so we sent her home for a test run over that first weekend-and everything worked out perfectly. Her name is now Lilly-it really suits her. She is sleeping on the couch with the rest of the family and her once reserved/shy personality is no longer; she has really blossomed with the love and security of her new home and wonderful family. She is in a forever home, and we couldn't be happier for her. OK, there ARE good humans out there!

We got to see Lilly today for her spay and some much needed dental work-she had some infected gums and diseased teeth that were likely causing her some pain. We took some dental x-rays, extracted the bad teeth, cleaned up the others and will get her started on some preventive dental care when she goes home. She actually had a big abscessed tooth and will get some antibiotics, definitely not a routine part of dental work.

I thought I'd take this opportunity to explain just what a "spay" procedure entails. We hear about them all the time, but few people actually know what is involved in the surgery for an individual animal. We talked a little about it in the blog "There's No Such Thing As A Routine Spay." The term "neuter" is traditionally used to refer to the surgery to sterilize male dogs or cats-technically a castration procedure. But a neutered animal can be either a male or female animal who has been altered; it is just more common to refer to the female surgery as a "spay."
Different veterinarians may do the procedure differently; ligating and removing ovaries only-an ovarioectomy, or the much more common removal of both ovaries and uterus-an ovariohysterectomy. Some veterinarians, particularly those trained in Europe, prefer to perform the procedure through a flank approach into the abdomen-on the side of the animal just behind the ribs and in front of the pelvis but below the thick spinal muscles. It is more common to find American animals spayed through a ventral midline incision-a line made from near the umbilicus or belly button down towards the pelvis on the underside of the belly. These incisons are traditionally very short. This can be an unsafe habit for a surgeon to get into, as visualization of important liagures is impossible from one of these keyhole incisions. Owners undoubtedly like smaller incisions, but if the reason for longer ones is explained, few will complain. Besides, incisions heal from side to side, not top to bottom. A 3 inch line will heal just as quickly as a 1 inch one!

After the initial incision is made into the abdomen, some fatty tissue may need to be removed for better visualization. No, this isn't liposuction! We simply cut away any excess fat that has been deposited in our line of sight, making it much easier to see the organs and ligatures we will make.
Have I mentioned before how important visualization is? We are dealing with very precious patients and spays are major surgeries for these girls. I suppose some veterinarians are adept at the "Braille" method after doing hundreds and hundreds of these procedures; I for one want to be sure I really know which organs I am removing, which vessels I am tying off, which ones I am cutting, and being able to SEE these is the only way for me to be certain.

The next step is to exteriorize one side of the uterus. Unlike humans, dogs and cats have uterine horns-2 long sides and a short body designed to hold multiple fetuses-humans just aren't designed to have litters. We use a special instrument called a spay hook or snook hook to fish the first horn free from the rest of the abdominal contents, definitely relying on feel and knowledge of normal anatomy to know where to look for it. It can be very small in even a very large dog if she has never had a heat cycle yet-there has been no estrogen influence on the organ and therefore no reason for it to develop. It can literally get lost amoung all those other organs, intestines, omentum and such. Sometimes just finding it is the hardest part of the surgeery!

I then bring out the ovary which is located at the end of this uterine horn, often hidden within more fatty tissue. It is usually located near the kidney up against the back of the body, attached with a ligament that can be broken down with a "strumming" of the finger. I rarely cut these with scissors or scalpel blades, although that ligament can be quite tight in young dogs. I like to place clamps and ligate blood vessels supplying the ovarian "stump" with a type of suture material that will slowly absorb on its own. Suture material that is too slick may slip off the vessels or stump or may not produce a secure knot. Surgeons develop their own preferences for suture materials in various circumstances.

The procedure is repeated for the other side, but you don't have to search for that one-you can just follow the horn down to the bifurcation at the uterine body, then over to the other side. The uterine stump is then ligated near the cervix, often with a transfixation ligature. This means that the suture material is passed through the organ to attach to it in one or more places, making it less likely to slip off after tightening down on it. All three sites (both ovarian and one uterine) are checked carefully for bleeding and then we can close up the midline incision.

Closures of the incsion vary with the surgeon. I generally close in two layers-the linea and the subcuticular layers. The linea is the thin white line, anotomically called the linea alba, that runs the entire length of the midline and is the connective tissue junction of the two sides of the body. Since there is no muscle tissue here, the closures involving this tissue is less apt to swell, is less vascular and seems a more comfortable closure. I believe animals tend to lick or chew less when muscle isn't incorporated in this layer. The subcuticular layer is basically under the skin or within the skin; I like closing without visible stiches outside the skin to again discourage pets from bothering the incision. It also seems to make for a more cosmetic appearance to the skin closure. These also absorb slowly over time. Sometimes I need to apply a drop or two of tissue adhesive or skin "glue," particularly over suture knots to ensure skin completely covers the suture material. On the rare pet in which I use skin sutures, I will place a few non-absorbably sutures or even surgical staples across the incision. Some videos of the actual spay (and castration) surgery are found here: Shelter Surgeries

Pets are sent home with pain relief medications to allow for a comfortable recovery period-about 7 - 14 days. They often need to wear e-collars or the silly satellite dishes or cones around their necks to prevent the licking or chewing that can occur with even the best dog when they are unsupervised. It is extremely rare for these girls to need antibiotics unless there is a pyometra or literally pus in the uterus. We like to see the patients about 1 week after surgery to be sure they are healing properly and to answer any questions an owner might have about their care.

Spays are a very important part of any veterinary practice. Unspayed females are at a much greater risk of mammary cancers and pyometra, as well as contributers to the problem of pet over-population. While definitely not routine for the individual animal, it is a "rite of passage" for a young female dog. Lilly is currently snoozing away, comfortable in her warm kennel and having received her pain medications for the evening. She ate a small meal and walked outside earlier; I'm pretty sure she will do well tonight and get to go home to her wonderful new home first thing tomorrow. Such a happy ending for such a happy girl.


Monday, February 2, 2009

Doesn't All Poop Smell Bad?

Poor Maximus, errrr...Maxine. He/she came in as a rambunctious boy kitten and went home newly "diagnosed" as a little girl. "Max" works for both boys and girls, thank goodness.

Max came in with his her big sister, a geriatric Siamese kitty named Lexi who is rather vocal about her predicament-having to live with and raise a rascal-y kitten is one thing. Going on a car ride and visiting the vet is entirely different. Both look to be very well cared for-I think Max has scored getting this family to live with.

Unfortunately Max has a bit of a problem-not that he even cares about it. He is very busy and energetic and yes, terrorizing all his brothers and sisters as any good kitten should. But his problem could become an issue for him over time, resulting in dehydration, electrolyte imbalances, weakness and failure to gain weight or worse. Max has diarrhea.

Now in an otherwise healthy adult animal, diarrhea wouldn't be a big deal; even in Max I am not worrying too much. Her owners are concerned, and rightly so, because it has been going on for some time now, and if it was attributable to just a simple diet or environment change as they originally thought (very common in newly adopted kittens and puppies) it certainly should have resolved by now. Instead it may even be a little worse, and boy is it stinky!

So, yes, all poop smells pretty bad. But the diarrhea remnant left behind on her fluffy bum hair is particularly foul-and she just isn't keeping up with grooming herself like she should. Max had been given some de-worming medications at the pet store that sold her, but testing her feces for parasites was still a good idea. We talked a little about this procedure in the "Ewww, Gross" blog a while ago. Having had diarrhea for so long, her distal colon was pretty empty, so we sent home a collection device for her owners to bring back after she gives them a fresh sample. In the mean time we were able to perform a test for giradia; Max tested positive for this. This was likely contributing to the diarrhea.

Giardia is a protozoa-a single celled organism found in the environment where it has been shed through the feces of infested animals. It is the reason we have to boil our water from streams and lakes when we go camping in the mountains. Contaminated water, especially puddles at dog parks, are a major source of infection for our dogs and cats that we see in practice. We humans can contract it from our pets, but again, it is by way of the feces. After ingestion, it can take 5 to 12 days for the new host's body to shed the organism in the feces, but diarrhea can occur even before this. Diarrhea can range from mild to severe, with the above mentioned electrolyte and hydration problems resulting in very young, geriatric or otherwise debilitated animals. It is not generally associated with bloody feces. It does appear to be more common in kennel or crowded situations.

Although it can be difficult to diagnose giardia via a traditional fecal flotation test, it is possible to identify the organism on a direct smear microscopic examination of the feces. It shows up best if it is stained with iodine. There is a very good test that does not rely on direct identification of the organism but rather an immunologic test for giardia proteins. It is an ELISA test similar to a pregnancy test you take at home. It only takes a few minutes and is done while you wait during an office visit. That is how we identified Max's infestation.

Treatment of giardia can be frustrating. We start by using a broad spectrum dewormer (even though giardia is not a worm) called fenbendazole (Panacur.) Metronidazole, an antimicrobial medication, has been used, but can have neurologic side effects that are rather extreme, especially in cats. Giradia cysts can stick to the fur of the patient, so re-infestation is possible. We will let Max's owners know they should give her at least one bath during her treatment period.

Not all pets (or humans) will have diarrhe when infested with giardia. We like to test all of our new puppies and kittens, some of our most vulnerable patients, at their first visit with us and at any time we have an unexplained diarrhea, particularly an intermittant or on again, off-again diarrhea. There has been a vaccine developed to try and prevent giardia infestation, but it has not been found to be very effective and is not recommended in most situations. Decontaminating the environment is very difficult, especially with the possibility of re-infestation by wildlife, although a 1:32 bleach solution will kill giardia cysts.

Max is on her way to recovery, going home with some Panacur granules for her owners to add to her food for 6 days. We also gave her some probiotics to help replenish the "good" bacteria in her intestines. If her diarrhea does not resolve after this treatment, we will search further for any other possibilities. Max's poop should go back to just being normal-smelly, not giardia-stinky.