My Pets Live With a Vet!

Moving On

2010-11-08T17:42:00.000-08:00

This post won't have much to do with veterinary "stuff," but it does have to do with that incredible connection some of us have been fortunate to share with a very special animal in our lives. It is just personal ramblings-so won't be for every one.

Many of you know I lost my best friend, Verbal, earlier this summer-on Father's Day in fact. I never knew a heart could break like that. I have been so lucky to have good, understanding humans in my life to help me through the loss, but ultimately it has been just a terribly lonely and painful ordeal. Any one who has lost a "heart" dog or cat (or horse or rabbit for that matter) can relate to some of what I went through, and many people have been helpful in relating their experiences. Some told me of dreams or visions they had of their beloved departed pet-and how comforting that was for them. The dream was a way for that pet to "communicate" to their human, to let them know they were doing well, moving on, watching over them, or whatever the message was that they felt their owner needed to receive at the time. Regardless, it was almost always a means of closure, and I was so envious of that!

As time passed, I kept wondering why in the world I wouldn't dream of my dear Verbal dog. We had shared so much in this life, had been so very close, and I began to worry that maybe she WASN'T in a peaceful place, watching over me, maybe she was scared, alone, couldn't "move forward," that I had left things unresolved-you know how a grieving mind can work. I know my husband hurt, too, but he was getting on with life, and he didn't know what to do with me when I was crying my heart out every night. After a month of that, just exhausted from the pain, I did what I thought I "should" do-I got a puppy.

I visited only two puppy "brokers," and that is exactly what they were. The first was a true puppy mill, no matter how nice things might have seemed on the surface, and I couldn't in good conscience support that "business." The second was an actual rescue situation-adult dogs being bred well past "retirement" ages. There were 10 and 12 year old momma dogs with mammary tumors, flea and worm infestations and who knows what else-and I don't think any one could really match up which parents went with which puppies. Selling puppies would help the rescue group get the older dogs spayed and neutered and re-homed. I wished I could have stepped up and taken an older dog, but after just losing one old dog, I knew my heart wasn't in any kind of shape for that. I used my check book to help with what I could, and scooped up a mangy, pot-bellied skinny yellow puppy, was handed a bag of "Atta Boy" dog chow to tide her over ( give me a break,) and headed home.

I texted a picture of her to Michael on the way home. I just got the reply "It's a puppyyyyyyy!!!!" so figured that was an approval of sorts. It really didn't matter much-it was love at first site.

I'll fill you in later on the antics of "Alvy" and her wily ways of working her way into our lives...and hearts over the past few months. Suffice it to say, she has grown from a scrawny 10 pound 9 week-old babe to a pretty robust 6 month-old DOG now.

This past Saturday was a pretty terrific day all around. I soooo wanted to sleep in on that rainy morning, but made myself get up early so I could take Alvy to her training class. We are in a program called Sit Means Sit, and I can't say enough about how well she and her class mates are doing with their training. I should say "our" training-probably 80% or more of dog training is training the humans, and I am definitely in that category. We all meet in "real world" situations-parks and schools-so face all the distractions that are inevitable. It is amazing to see even very young puppies focusing on their humans, intent on figuring out the puzzles and wanting so very much to please. They have such a great time in the classes-lots of work, but lots of breaks to run around and play with classmates or tug on a toy, fetch a frisbee or yes, jump in puddles or whatever. I will certainly write more about this amazing training system-I'm a big fan, not only because of how well Alvy and I are doing, (she was "spotlight client of the month" in November-check out her Bio on their site) but also because so many of my clients and patients have taken part in it and some have begun solving even some major problems like aggression.

After class, Michael and I decided to take Alvy over to a dog park I read about on Whidbey Island. Now, we have plenty of dog parks around here-so why take a ferry ride? Well, the weather has a tendency to be a little better over on the Island, and this dog park just happens to be on a BEACH! Oh boy! Alvy had never been to a beach, and I was very excited to introduce her to all that meant. It was a great choice. The dogs were allowed to be off leash while on the beach itself, so Alvy could run play and body slam with all the other dogs-and of course, find all the dead stinky things to roll in, waves to jump in, and salt water to lap up (before she figured out that wasn't such a great idea!) We must have played for 2 hours-I thought I'd have to carry her back to the car, but she made it just in time to collapse on the pile of towels I actually remembered to bring. She was so darned happy! It did my heart good to give her this gift. I know we have other beaches pretty close, and this one really wasn't far at all-we will be doing the beach thing a LOT!

You can imagine we all slept very well that night. I had actually been pretty sick for several months and was finally starting to breathe better and sleep through an entire night without waking up in fits of coughing. And guess what happened that night? I dreamed about my dear sweet Verbal dog! It wasn't anything earth shattering or unusual-she didn't talk to me or anything like that. She was just comfortably walking by my side as she always did-and now I knew she always would-my old friend was there by my side, or rather, we were together, by each others sides-forever.

I know that after 5 months of wishing and hoping for a "sign" from her, my dear Verbal came to see me after we gave Alvy a perfect day-and she told me that was as it should be. Life goes on. The young whipper-snapper deserves all the love we have to give her (and all the stinky dead things to roll in!) Verbal was telling me that Alvy was lucky to have come in to our family-she would always know love and care (and fun!) but we are lucky to have her in our lives, too. Verbal would have hated having the youngster around her-it is why we never did have other dogs while we had Verbal. Young puppies were big ol' pains, disrespectful of older dogs who might be hurting like Verbal did. Despite this, Verbal was acknowledging that her humans' happiness was the most important thing to her-and if this obnoxious puppy could give us that happiness, that was as it should be. And by the way, she (Verbal) wasn't going anywhere. She would be right by my side as that puppy frolicked ahead. Moving on certainly doesn't mean replacing or forgetting.

Oh my. I have never been more relieved (or more happy) to have dreamed such a simple thing. It only took 5 months of wishing and hoping and praying...

A few hours later I was in church...and realized it was All Saints Day. We lit candles in memory of family or friends who died this past year. You can bet I lit a candle for Verbal. She was family. She was my friend. There was no one who better fit the qualifications. A friend sent me the link to this very sweet song/poem about dogs and God-check it out if you have the time. God and Dog

I have had quite a few friends and clients ask me when I might start to blog again. I don't know if I can keep up the momentum, but telling this story of Verbal's dream visit seemed worthy of an entry, maybe the start of something regular. But regardless, it is a pretty good story, isn't it?

Peace,
DrReneigh

That's a Mouth Full!

2010-02-05T11:25:00.000-08:00

This week one of my tiniest, sweetest little patients was diagnosed with a problem that is quite a mouth full to pronounce: crycopharyngeal achalasia. Whew! It made me think back-WAY back-to my first medical terminology class. I took it as an undergraduate student at Cal Poly in San Luis Obispo. I liked it because it wasn't a course where you had to memorize lists and lists of those mile-long, foreign words. Instead, we were taught how to break down those words in their prefixes, suffixes, roots and parts-dissecting them if you will- and this way found we actually knew the meaning of most of those daunting words, even if we had never heard each one before.

We started with the basic terms we learned in our anatomy classes, words describing parts of the body, organs, etc. Derm refers to the skin, osteo to bone, cerebral to the brain, cephal is the head, coreo is the pupil of the eye, and cardio the heart. Cysto refers to a bladder, renal or nephro to the kidneys and hepatic to the liver. Chol refers to bile or the gall bladder. Ovo refers to the ovaries while orch refers to the testes. I wasn't amused when we learned that the root for uterus was "hystero" because females were considered "hysterical" by their doctors. Wonderful. Metra can also refer to the uterus.

We then learned the prefixes that describe these organs or conditions. "A-" can simply mean without or not. "Neo-" is new or recent. "Bi-" means two or double. "Iso-" means equal or alike. "Endo-" means within. "Pyo-" refers to purulence or pus.

Suffixes might further describe or quantify conditions or situations. "-algia" refers to pain or a painful situation. "-itis" refers to inflammation. "-osis" simply refers to "the disease or condition of." "-lith" refers to a calculus or stone. "-otomy" means to surgically cut into while "-ectomy" means to surgically remove and "-ostomy" means to crate a permanent hole in. "-oma" usually refers to a benign tumor while "sarcoma" refers to their malignant counterparts.

So, let's try out your new skills in medical terminology. Break down the big words into their smaller, more familiar parts and see what you come up with. You will be surprised how easy (and even how fun) it can be!

1) Dermatitis
2) Nephrectomy
3) Pyometra
4) Endocardiosis
5) Cholecystolith
6) Ovariohysterectomy
7) Osteosarcoma
8) Acholiosis
9) Tracheostomy
10) Isocoria

Ok, here are the answers-I'm sure you got all of them right!

1) Derm-skin + itis-inflammation = inflammation of the skin
2) Nephro-kidney + ectomy- surgically remove = to surgically remove the kidney
3) Pyo -pus + metra- uterus = pus in the uterus or a uterine infection
4) Endo-within + card-heart + osis-condition or pathology of = disease inside the heart, actually refers to a disease of the heart valves (which are inside the heart-see how this works?)
5) Chol-bile/gall + cysto-bladder + lith-stone = gall bladder stones
6) Ovario-ovaries + hyster-uterus + ectomy = removal of the uterus and ovaries-in dogs or cats, we call this a spay surgery.
7) Osteo-bone + sarcoma-malignant tumor = bone cancer
8) This one looks hard, but just break it down...a-with out + chol-bile + osis-condition of = the condition of not being able to produce bile.
9) Trache-refers to the trachea + ostomy-to create a permanent hole in = creation of an opening into the trachea.
10) Iso-the same + coria-refering to the pupils of the eye = having pupils that are the same size.

Look at that! I knew you could do it. See? Doctors really aren't all that smart. Using big words just makes them sound that way, and now you know the secret behind doing that, too. And it doesn't even give you cephalgia (a headache) to use those big words, too.

Peace,
DrReneigh

No Puppies for Heike

2010-01-26T15:05:00.000-08:00

Heiki wasn't feeling quite herself. Normally vivacious, full of life and energy, the first day we saw this wonderful Coton de Tulear, she was a little down. She was fortunate to be owned by a very observant lady who noticed early on when something wasn't quite right and brought her in for an exam. She noticed that her appetite was off the past two days or so, and most significantly, Heike had some clear, shiny discharge from her vulva which she kept trying to lick clean. Her temperature was a bit elevated, too. Heiki's owner also happened to be her breeder-and was very knowledgeable that these symptoms could be signs of trouble with the reproductive tract. She told me that Heike had been bred 3 weeks earlier.

By far, most breedings of dogs happen with no problems at all. But the process isn't exactly sterile, and bacteria can get introduced into the reproductive tract of the female dog during mating. They will migrate up through the cervix, which is relaxed during estrus instead of being closed tightly as it is during the rest of a dog's cycle. The bacteria then start to reproduce in the uterus, creating an infection here we call a pyometra-literally "pus in the uterus."

We can see two types of "pyos," open and closed. These descriptions refer to the cervix, and tell us if the infection is trapped or contained in the uterus creating a life-threatening "balloon" of infected material or if the bacteria and pus is able to drain or leak out of the uterus through the cervix. Both are incredibly serious problems for any dog, much less a breeding female.

Now, the discharge coming from Heike's reproductive tract at this point didn't look like pus-it was clear with no blood or other cells in it at this point. We decided to do an ultrasound exam of her uterus and see just what was going on in there. We shaved some of her glorious long white hair from her abdomen and very quickly confirmed that Heike was, indeed, pregnant. This certainly made our treatment decision more difficult-if it was at all safe to do so, we would like to be able to continue the pregnancy. Since we suspected the discharge could be normal or could be early signs of the pyometra infection we were concerned about, we talked at length with Heike's owner. Another possibility was that the pregnancy was trying to resorb or abort for some reason. We trusted that Heike had the type of owner who could carefully monitor her condition, give medication as directed and watch for the changes we discussed. If Heike stopped eating or started vomiting we wanted her right back in. If her temperature increased, or if the vulvar discharge turned milky or creamy we needed to recheck her. Many dogs with pyometra will start to drink water excessively, so we wanted to watch for this, too. Since we knew she was pregnant, monitoring for a distended abdomen wasn't going to be very helpful. But if she became painful in her belly, that would be a bad sign. We gave Heike a prescription of an antibiotic we felt would be effective for an infection in the uterus but would also be safe for developing puppies, gave her some fluids under the skin to help her hydration and slight fever, and sent her home.

Heike's owner was diligent in medicating her and giving her fluids, orally and subcutaneously. She monitored her vital signs as we asked, and Heike did pretty well for about a week. About that time her temperature actually decreased to below normal and she stopped having any vulvar discharge. We had her come in to reevaluate, and did some blood work and another ultrasound exam. The blood work showed a significant elevation of her white blood cells, a tell-tale sign of infection in the body despite the week-long antibiotic treatment. The ultrasound exam showed that the pregnancy was not progressing as expected. In fact, while we could see the individual vesicles of amniotic fluids, no evidence of feti were found in those vesicles. The uterus itself was very large and fluid filled. With no vulvar discharge seen now, we diagnosed a closed pyometra.

As mentioned before, a closed pyometra is a life-threatening condition. As the uterus fills with pus, the wall of the organ becomes stretched thin and attacked from within by the bacteria, weakening the tissues and making rupture of the organ very possible. The only treatment is an emergency removal of the uterus, hopefully before any rupture or leakage of any amount occurs. We rearranged our schedule and got her right into surgery. It was a good thing we didn't wait.

Normally a thin band of tissue, sometimes even difficult to find among all the intestines and other abdominal contents, Heike's uterus was huge, bulging up right under the incision I made in her abdominal wall. I exteriorized it carefully, revealing the "balloons" we saw on the ultrasound exam.
While thinning in some areas and obviously very diseased tissue, there were thankfully no obvious tears, ruptures or leaking areas. Gentle handling was essential to keep that from happening. I wanted to remove the entire pus-filled uterus, along with both ovaries and the supporting tissues without spilling the contents into the surgical site. Unlike in a human female where the uterus has a simple body, (just fine for a single fetus) the uterus in a dog consists of two "horns," much better suited to accommodate the numerous developing puppies or litter. You can see Heike's diseased uterus kind of looked like big sausages-very abnormal.

We were able to remove both of Heike's uterine horns and ovaries without obvious pus contamination of the abdomen, but we flushed out her abdomen with warmed, sterile saline as a precaution, explored the rest of her abdominal organs briefly and found no other problems, and closed her incision. After we removed the diseased organ from her body, we opened it up and found that, sure enough, it was filled with a huge volume of a nasty, strawberry milkshake colored liquid that anyone could tell wasn't normal. The entire surgery was less than 30 minutes, but without it, this sweet little dog would certainly have died from that infection.

It is tempting to treat these dogs like those we have spayed-just a "routine" procedure, especially when they do as well as Heike did. But that would be a mistake, and could have resulted in a decline in her condition later. There was nothing routine about needing to rush to surgery right away. Heike had no time for adequate preparation before surgery, such as fasting, and she was only started on her IV fluids minutes before I made the incision into her abdomen. That uterus was hardly normal, and her blood work showed an obvious affect on her entire body from sepsis or pronounced infection. Her lower than normal body temperature was a sign that her body could no longer handle things on its own and might be facing impending shock. Heike was placed on a different, more powerful antibiotic, one we couldn't use earlier when we had a potential pregnancy to consider. She had aggressive IV fluid therapy and her nurses got her body temperature back up to normal-and kept it there. Her surgical pain was managed well with narcotics before and after surgery, as well as a non-steroidal anti-inflammatory medication. She was also sent home with an appetite stimulant, as getting her to eat right away would be very important to her healing process.

Heike was fortunate that her owner knew the signs of pyometra and how serious it could be. Even if an owner didn't know about this disease specifically, just knowing the "normals" for your pet, his or her normal habits, appetite, activity level, etc. really goes a long way to helping know when something just isn't right. It is the veterinary team's job to then try and figure out why that is-working as a team, we got Heike all fixed up, sent her home to her owner and when we later rechecked her, found that she was the happy, healthy dog she had always been.

But even happy and healthy isn't enough if you are a female dog living with a breeder-and you don't happen to have a uterus! Heike needed to find a new home, and that she did. She actually got to make a plane trip across the country, and now lives with another sweet "cotton" dog, MC. Heike is now known as Olivia-and she couldn't be happier! Her new owner opened her home and heart to this sweet little girl. We are glad that everything has worked out so well for everyone. Good luck, sweet Olivia!

Peace,
DrReneigh

Lucy is #100!!

2009-11-30T22:14:00.000-08:00

Lucy was normally a feisty and trouble-making tortiose shell kitten. Well, yesterday she had the trouble-maker part down pat. Her feisty personality was toned way down, though. She had vomited the day before, a piece of what looked like gift-wrapping ribbon. And there was blood in the vomitus. If that had been all, and she had gone back to eating and tormenting her brother and all, well, that would have been that. But Lucy's mom just had a feeling about her, and I have learned never to dismiss a mother's intuition. She brought her in first thing in the morning-and I am glad she did. Lucy's usual glossy hair coat was oily and rough-she wasn't grooming herself. Her gums were tacky and dry-she was dehydrated. And when I palpated or felt her abdomen, she became very tense and painful-different from the normal-"don't do that, I don't like it" reaction most cats will give me. It might be a subtle difference, but like her mom, I knew it when I saw it.

Because of her history of vomiting up what looked like ribbon, we decided to take some radiographs of her abdomen right away. Now, for most patients with a little vomiting or gi upset, I don't usually jump right to x-rays. They are expensive, and by far most pets are going to get better with a little tender loving care, maybe a fast, some fluids, bland food, etc. But remember her mother's intuition? And remember her painful abdomen? And remember she vomited blood and ribbon? Those symptoms all added up to trouble-and I wanted to be ahead of the game with Lucy's diagnosis. I'm glad we took the pictures.

Lucy's radiographs showed a whole lot of "stuff" in her stomach-lots of very distinct lines all packed together-nothing readily identifiable. Her owner said she hadn't been fed since the night before, (and she didn't know if she ate then or not-she does have another kitten in the household.) Lucy hadn't had any breakfast, so she shouldn't have had anything in her stomach at that time. Since I couldn't identify just what it was, but knew it shouldn't be there, and because that meant a pretty big next step-surgery-I wanted a second opinion on the films.

We have all of our x-rays read by a board certified radiologist-I learn a lot from him and it is a lot of comfort to have that second set of eyes when I'm just not sure of what I'm seeing. Our local veterinary reference laboratory provides a courier service for the films themselves, (I haven't made the 70+ thousand dollar investment in a digital system yet...) picking them up and delivering them to the radiologist's office where he interprets the films, faxes us a copy of his results, and sends the films back via the same courier service. This is a very handy and speedy service, but still takes a day or two at best. We can occasionally arrange for "stat" pick up and delivery of films, but there is a considerable extra fee involved, and still some delay. Since I was worried about the liklihood of imminent surgery for little Lucy, I asked her owner to hand carry the films to the radiologist's office herself, saving the fee and resulting in much faster results. Lucy stayed with us, and so did George, her big brother-more for moral support for HIM. He couldn't bear being seperated from her!

All this worked out very well. In about an hour the radiologist gave me a call and concurred: the radiograph findings suggested we should do a "peek and shriek" surgery. In proper medical terms, an exploratory laparotomy. I like "peek and shriek" just fine. They are usually quick and we usually find some pretty impressive things to "shriek" about in these surgeries-and Lucy's was no exception.

We called Lucy's mom and told her what she was already suspecting-Lucy would be going to surgery right away. We called a few other owners to rearrange the schedule-those with "routine" appointments for things like vaccinations had no problem resceduling for another day. Others with ill pets, just not as critical, got moved to a little later-all knew that if it were their pet needing the emergency attention, they would be first in line. That's just how we do things here, and everyone is usually very understanding.

I have to mention here how very lucky Lucy is to be owned by such good humans. Not only did they recognize her signs of illness and bring her right in, they also accepted the responsibility and need to care for her, making big sacrifices during this holiday season so they could provide the care she required. We all know that isn't the case with all of our animal friends, especially in these difficult economic times. Hurray for Lucy's humans!!!

Schedules were rearranged, the staff swallowed some pizza I got for their lunch and off we went to surgery. Lucy did great, and so did her team. She was anesthetized and prepped for surgery, and I was in the surgery room with her in record time. It didn't take long to find her problem. Her stomach was the size of my fist, (That's pretty darned big for a 9 pound cat!) and although outwardly it looked just fine (no signs of perforations or necrosis, thank goodness) it was rock hard. I ran through the rest of the gastrointestinal tract and found it was completely empty-whatever was in the stomach had prevented anything from entering her intestines for quite some time.

After ensuring that the stomach was the sole problem area, I performed a gastrotomy-an incison into the stomach wall.
The contents were pretty impressive-wads of what appeared to be plastic strips and elastic bands-hair bands and maybe even a small bungee cord. And yes, there were many pieces of colorful ribbons, too. Lucy had been collecting these goodies for quite some time.

We saved all these treasures to show her owners-after all, they were paying good money for retrieving them! Hopefully they would be able to identify them-and then be able to "Lucy-proof" their home a little better than they thought they were. Her incisions were closed up, Lucy was given some good pain medication, and she was tucked into her recovery kennel, nice and toasty warm. She was a bit slow to wake up, but there was no rush. We monitored her carefully, and by the end of the day, she was doing just fine. She even ate a couple fingers full of food! We set up some nurse checks and I put my web cam on her so I could monitor remotely. She got a little over heated with all the heat lamps, heated kennel and heated rice bags, so those were removed during the night, but otherwise, everything went smoothly. Lucy had another dose of pain medication this morning, and soon after she began eating like a pig! She wouldn't let poor George any where near the food dishes. She must have been starving for actual real food-hair bands don't have much nutritional value.

Lucy's owners came this morning to pick up her and her brother-the house must have been awfully quiet without those two last night. We went over her care instructions-I don't usually consider gastrotomy patients "out of the woods" until about 10 days or so post-op. That would give the stomach incision plenty of time to heal and digestion to start up again. If any leakages were to occur, infection would become obvious during this time. All in all, I was quite pleased with how she did, and expect her to recover just fine. Now it is up to her humans to keep her away from those darn enticing stringy things. My own cat, Stella, has an addiction to curly ribbon-she can just smell a package wrapped with the stuff when it enters the house and is immediately drawn to it, chewing frantically unless I intervene. It is weird just how much certain cats love to chew on things like this-ribbon, string, yarn, tinsel, dental floss, and yes, hair ties. If you don't know what your cat's predilection is for these things, don't take a chance! Keep them in drawers or cabinets or in covered bins. Surgery is no fun for any one. (Well, I actually DO like these types of surgeries :) "A chance to cut is a chance to cure." In Lucy's case this adage is particularly true.

Wow! Lucy's story makes 100 blog entries! That is quite a milestone, especially since I took the last 3 months or so off. I hope you have had some fun reading about the various patients that have come and gone in our busy little hospital-maybe were grossed out by a few stories, laughed at some, shed a tear or two at others. I tried to always add a little "educational" aspect to most of my blogs-hopefully teaching fellow pet lovers some new things about their friends, reminding you of situations to be aware of or just exposing you to an aspect of veterinary medicine that you might never have considered before. Some veterinarians are called upon to do some pretty amazing things-from realigning the broken bones in the leg of a puppy accidentally stepped on by the playing children, to stuffing the intestines of a "broken" spider back in his body and super-gluing him closed. Some of us who enjoy surgery might get to repair a torn ACL on a rambunctious lab or pull hair ties out of a kittens packed stomach. We occasionally get to diagnose rare or exotic illnesses, and the outcomes may not be good-but hopefully we learn from them, too. With all this knowledge and technology at our hands, we still have a "few" limitations. (Ha ha! I wish it were ONLY a few!) But I was referring in this instance to a limitation I have often wished we didn't have-we still aren't capable of installing zippers into the bellies of patients who repeatedly eat things they shouldn't eat.

Peace,
DrReneigh

A Big Dog With a Big Problem

2009-08-27T13:59:00.000-07:00

Kodi was a BIG dog-a gorgeous 120-pound Malamute- who had a very big problem-his kidneys weren't working like they should. For him, this meant the waste products of every day metabolism that build up in the bloodstream just kept rising, unable to be filtered by those failing kidneys. Now, Kodi wasn't an old dog as you would have expected. Older patients get things like organ failures-they just wear out after years and years of use. Sometimes they get cancer in those organs. This just wasn't the case for Kodi-he was only 4 years old. As we attempted to treat Kodi for the obvious problems resulting from his kidneys not working, we also had to go on a hunt for possible causes of their failure-or we might not be able to stop it from happening again.

Since kidneys are a filtering organ, anything that travels in the blood stream and accumulates in the kidneys could potentially casue those organs problems. Drugs like non-steroidal anti-inflammatory medications can do this, especially ibuprofen, a drug really meant for human, NOT canine use. Other medications humans routinely take could have renal toxicity problems in dogs, but Kodi's owners were fairly certain he didn't have access to anything like that. They hadn't given him anything as some people do, "just to make them feel better" before resorting to a veterinary visit. We couldn't think of any plants or yard products/chemicals he could have eaten, and they hadn't changed their anti-freeze in their cars recently. Anti-freeze is a well known kidney toxin.

There are, of course, primary diseases of the kidneys themselves-infections like pyelonephritis which can develop from bacteria that travels up the urinary tract from the bladder to the kidneys when a pet has a bladder infection, often unnoticed by owners. The blood work we did on Kodi did not indicate any infection in his body right then, but it was still a slight possibility.

Leptospirosis is a bacterial disease that can affect the kidneys of dogs, as well as humans. Wild critters such as possums, racoons and rats can be the carriers, spreading the organism through their infected urine. The disease can be serious for both humans and animals. In people, the symptoms are often like the flu, but sometimes leptospirosis can develop into a more severe, life-threatening illness with infections in the kidney, liver, brain, lung, and heart. Because we had put many of the other possibilities for Kodi's kidney problems lower on the differential or "rule-out" list, leptospirosis worked its way higher up the list. Testing for the disease is done via a blood sample, but results often take 10 days to get back. Since the treatment for the leptospirosis bacteria itself is done with antibiotics, we decided to start Kodi on these right away rather than wait for the test results to come in.

Leptospirosis is one of the "big" diseases we usually vaccinate at-risk dogs for every year, but unfortunately the vaccine does not provide 100% protection. This is because there are many strains (types) of this bacteria, and the vaccine does not provide immunity against all strains. It is important to get your pet vaccinated again even if it gets leptospirosis because it can still get infected with a different strain of leptospirosis. Kodi was vaccinated each year for 4 different strains of lepto, but his test came back positive for another strain, one for which a vaccine is not available. It was a good thing we had started him on antibiotics when we did. when we got the test results back, we also started his house mate, Kiona, on a prophylactic course of antibiotics. She wasn't showing any symptoms of the disease, and we certainly wanted to keep it that way.

As mentioned, treatment for the leptospirosis bacterial infection is antibiotics, specifically those in the penicillin family. These will arrest the on-going infection, but dogs can remain carriers of the disease unless a second antibiotic from the tetracycline family is used, often for 6 weeks, to break that carrier state. Kodi was initially put on injectable ampicillin since he was so nauseated and anorectic from the kidney disease that resulted from the infection. And this was the big problem: we had a handle on the disease and could get it treated, no problem. But the damage it had already done to Kodi's kidneys was severe-he was hospitalized multiple times, once for 4 days in a row for 24 hour a day IV fluid therapy in a attempt to diurese his blood and get those kidneys working again. It never worked. His owners were terrific. They did everything we asked of them, bringing him in for testing, for hospitalization and treatment despite the considerable time they had to take off work and expenses they incurred. He spent a lot of time with us and in the emergency hospital when we weren't available.

We really expected such a young, big, strong, dog to turn the corner any time and make a full recovery, but it was not to be. Kodi's initial bloodwork showed just how poorly the kidneys were doing, and his first retesting of their values showed good improvement. Kodi was given very aggressive care, including those antibiotics, fluids, anti-vomiting medications, prescription renal diets to require less work on the kidneys while providing good nutrition for healing, antacids, appetite stimulants, phosphate binders (phosphorus levels go sky-high in kidney failure patients, making these patients very weak and wobbly, and Kodi was no exception)-you name a drug in our pharmacy and he probably was on it at one time or another! Subsequent testing showed no changes in those kidney values, and his phosphorus levels worsened, making him even weaker. His owners were reaching their limits of what they wanted to put him through, and frankly, what they could afford to spend. When Kodi finally became painful-his kidneys evidently swollen and tender-he was crying out as only a 120-pound Malamute can-his loving owners made the choice to end his suffering and said goodbye. It was a terrible tradgedy-his owners did everything right, loved him, fed him right, provided him with good preventive health care-and it just wasn't enough. They unselfishly did the right thing for him that weekend, as hard as it was on everyone involved.

Kiona is still symptom-free, and we fully expect her to stay that way. We had a little scare when one of out veterinary technicians became ill this week and made sure to alert her physician about her exposure to leptospirosis. In fact, we were required to report Kodi's case to the state veterinarian, that's how serious this disease is.

Definitely get your pet vaccinated for leptospirosis (the "L" part of a typical DHLPP vaccine) if he or she is at risk, and do your best to control the rodent/small animal population to minimize their urine in your pet's environment. Leptospirosis is out there, but is not a very common disease, thank goodness. If your pet has been confirmed by your veterinarian as having leptospirosis, don't despair. Early, aggressive treatment usually brings about good results. Kodi's case was rare and tragic.

Peace,
DrReneigh

Making Herself Right at Home

2009-08-10T23:18:00.000-07:00

So, the picture is a little blurry, but that is because little miss Raena was moving pretty darned fast. That big silver disc she is on is actually her exercise wheel, a pretty great design, considering most of the ones you usually see for rodents are made of open wire, and an open wire wheel caused Raena a huge problem a few years ago. She got hung up in it somehow (she wasn't telling exactly what happened) and broke her tiny little leg. We tried to fix it, but rodents aren't known for being the best patients when it comes to injuries like that, and Raena the chinchilla was no exception. Chewing at wounds and suture lines, and not understanding the meaning of "rest" or "taking it easy" until the bone could heal meant numerous complications, and she ended up having her left hind leg amputated. Not that you would ever know that today. She may have a goofy little swing to her gait, but when she gets going on her nice solid wheel, she looks like a pro! And boy, is she fast! We had her out in the living room the other night just to see her scamper around. When it was time to put her to bed-ha! it was crazy trying to catch that slippery little varmint! It really does my heart good to see how lively she is-don't even dare consider this girl "handicapped." A 3-legged chinchilla is just the most natural thing in the world, at least it is in a vet's home!

My husband Michael and I lost our first chinchilla, Edgar, last year. He was over 15 years old-quite a distinguished old man, and such a wonderful little pet. I don't think we realized just how much we had missed him until we learned that Raena's owner was asking about finding her another home. My hospital manager, Cori, had owned one of Raena's babies at one time, and she would have made a great home for her. But she has a very happy chinchilla already, and she didn't want to risk upsetting the balance of his life by adding another critter right now. I jumped at the chance to add Raena to our little family, and she came home with me last Friday.

You would think she would take some getting used to her new situation, needing some time to figure things out and all but, no, not Raena. She never missed a beat, jumping out of her travel carrier right onto her exercise wheel and going for a short run right when she arrived. Then she hopped over to the side of the cage and took a raisin from Michael-he was thrilled! It was one of Edgar's favorite treats, and now you can be sure she will be spoiled rotten by her new "dad." Raena wasn't even phased by the cats who came running over to see who was taking occupancy of the great big cage in the living room-they were pretty perturbed it wasn't for them! Anyway, Raena didn't even bat an eye at those natural predators, or maybe she was batting her eyes, winking and flirting, more like teasing those cats who are easily 6 or 7 times her weight!

Chinchillas are members of the rodent family, actually closely related to porcupines if you can believe that!, but also related to guinea pigs.

Yes, chinchillas were originally bred in captivity for their pelts-it IS wonderfully luxurious and beautiful, but it seems to me it would take an awful lot of those little guys to make a single coat! Current fur colors we see include white, silver, beige, and black. The chinchillas who were lucky enough to have lower quality fur were sold as pets, although some were used as research animals. That is how I got my first chinchilla, Edgar-he was losing all of the fur on his body, not exactly what they wanted in the fur-coat business, thank goodness! He was a wiley little dude-he grew a gorgeous thick silver coat after he came to live at our home and was no longer at risk of being made into a coat.

Chinchillas originated in the barren, mountainous regions of Peru, Bolivia, Chile and Argentina-particularly in the high altitude Andes mountains. The first known chinchilla ranch was founded in Chile in 1874 in Vallenar by John Murry, an English member of the famous scientific expedition "Challenger." In February 1923 an American mining engineer, Mathias Chapman, brought the chins to North America. He was in charge of several mines in the Andes and that is where he was introduced to the chinchilla. He took an immediate liking to the little guys and hoped that he could take a few of them home to California as pets. The export of chinchillas was illegal, however, he eventually persuaded the authorities to permit him to take eleven chins with him back to the States. Eight male and three female Chinchilla Lanigeras. He brought them down from the mountains and arranged passage on a Japanese freighter. And the story goes, (although this is almost certainly apocryphal) that all the chins in North America are descended from Chapman's.

In general, chinchillas are very friendly and clean little pets, and compared to most pet rodents, have very little odor. They can be quite shy and high-strung and therefore easily frightened, so they aren't the best pets for small children. It can be difficult to house multiple chinchillas in one cage, even in larger cages, especially if you have a more aggressive female chinchilla. Breeders and pelters have an interesting arrangement for their habitats to avoid "disagreements." They will create polygamous colonies with one male having access to five or so females maintained in separate cages. The male has a tunnel along the back of the females' cages which enables him to enter any cage at will. The females cannot pass through the tunnel because they are fitted with light-weight collars that are just a little wider than the cage opening.

Chinchillas are best housed in large, wire-meshed cages for proper ventilation, with or without a solid floor. They need some sort of enclosed nesting box to sleep in. They tend to be nocturnal creatures, spending a lot of time running around, eating and playing while YOU are sleeping-so be sure to oil that squeaky exercise wheel! Wood cages aren't a good idea because chinchillas are constant chewers, and pretty quickly your nice wooden cage will be a pile of saw dust! Ideal environmental temperatures are around 60 to 75 degrees F.

Raena has been fed a very good, balanced diet-but that isn't the case for a lot of the pet chinchillas we see. In fact, improper nutrition and/or husbandry (housing and care) are the most common causes of health problems in our little rodent and other small pets. She gets a pelletted chinchilla diet, although not all pet stores or feed stores will carry this. Using a standard rabbit or guinea pig ration is OK temporarily. Chinchillas like Raena are really cute when they eat, tending to pick up each pellet with their little hands, but they can be pretty messy, too, throwing a lot of pellets around the cage, so there can be quite a lot of waste. Raena has been pretty neat about her eating habits so far.

Grass hay is an important part of a chinchilla's diet as it adds fiber, important for proper digestion and teeth wearing (chinchilla's teeth grow constantly through their lives so need to be monitored for problems associated with overgrowth.) Hay also just gives these little guys something to do. Bored chinchillas often start to "barber" or chew on themselves, and many become bald as Edgar almost did. Alfalfa hay has the wrong calcium/phosphorus ratio for proper chinchilla nutrition, so should be avoided. Any hay fed to them should be clean with no evidence of mold, insects, or wild rodent contamination.

I mentioned earlier that Raena loved the raisin that Michael gave her. Dried fruit and nuts are great treats for chinchillas-and these little guys really do look like they are just relishing those treats! Fresh veggies are great, too, but all these treats should only be about 10% of the total diet. Because of their original habitat, dry, barren mountainous regions, chinchillas aren't used to taking in lots of fluids like what is found in fresh produce. They will likely drink much less water if they are offered these fresh treats, but their urine output should remain about the same. Be sure to monitor this for any changes or problems. Raena has a wonderful plastic corner box which she uses as a litter box. I just take that out and rinse it out every other day or so-it really cuts down on the need for an over-all bedding change in her cage. Pretty cool, huh?

One unique part of chinchilla husbandry is the need to offer them a dust bath a couple of times a week. Raena LOVES hers! She takes her dust bath in a little plastic box, big enough for her to twist and turn and spin all around, covering herself from head to tail with the lightly colored powder. When she is done all you can see are her two little eyes peeking out of all that powdered fur. The dust is actually a finely ground volcanic ash, and it serves to keep that wondeful fur clean, oil free and over all well groomed. I think it is just plain fun for them to spin around in the bath! Here's a good You-tube video of a chinchilla enjoying his bath:
Chinchilla Dust Bath
I don't leave the bath in the main cage all the time or it gets used as a litter box...and then it isn't much good as a grooming aid.

Raena is a pretty tame chinchilla, but she still doesn't like being handled all that much. In general, chinchillas are usually easy to handle and rarely bite (although any little critter can if agitated enough.) More likely, they might just urinate when they are annoyed about being held-so watch out! You also have to be gentle when handling chinchillas due to the possibility of 'fur slip." This is a sudden shedding of the hair coat in a patchy way that occurs when it is grasped or handled roughly. I haven't ever seen this happen-and I hope I don't! Doesn't 'fur slip' sound awful? As with any animal, just be gentle but firm when holding or restraining a chinchilla to avoid injuries to you or them.

The average life span for a pet chinchilla is 8 to 10 years, but there have been reports of some reaching 18 years! Raena is 6 years old right now, so she should have a good long life ahead of her-I sure hope so! She has already brought a lot of joy to our home, and I am so very grateful to her first owners for letting us adopt her into our family. I have been playing around with how her name is spelled, and even if we should keep her name as it is since it is so darned close to my own. I found several different definitions for her name, including "queen," "pure," and "song." We'll see how things work out. For now, our "pure little song queen" is working her way into our hearts....it isn't taking long to accomplish that!

Peace,
DrReneigh

What More, Verbal Dog?

2009-08-02T22:28:00.000-07:00

Regular readers of this blog (and anyone who knows me AT ALL) know all about Verbal. She has been my constant companion since she joined my life over 11 years ago, an adorable, 4-week old yellow puppy. This tiny, broken thing was presented to the hospital where I was then working by a supposed "breeder." I use the word loosely-what kind of breeder would cross a Golden Retriever with a Yellow Lab, and do absolutely no pre-breeding health or temperament testing on the parent dogs? As much as I love this dog of mine, I have had numerous times called her "my genetic disaster," referring to her terrible hip and elbow dysplasia, her numerous bouts with cancer (yes, debatable whether genetically linked or not) and her, at times, questionable temperament.

Anyway, this little puppy had been attacked by her daddy dog-evidently she got too close to his food dish and he mauled her. 4 weeks old and he broke her jaw and ripped her tongue off. The "breeder" brought her in to be euthanized-they couldn't justify putting any money into this one puppy when they had 8 others at home, and it was pretty obvious how they felt about spending money on veterinary care.

Well, I would have euthanized the dog that did this to the pup in a heart beat-what would stop him from turning on a child someday? But there was no way I could end the life of this innocent little ball of joy, wagging her tail despite the terrible pain she had to be in. My husband and I had just happened to purchase our first home literally one month prior to meeting this wayward puppy, and we knew that adding a dog was in our future.....Can you see the big word "sucker" tatooed across my forehead? Well, there's worse things, for sure. We had the owner sign over the rights to the puppy, and we did surgery to fix her up right then.

Her lower jaw was broken, so we placed a pin through the length of it. Her tongue was reattached, and we could only cross our fingers and pray that it would be functional after such a dramatic injury. To this day, she has a huge scar on the back of her tongue, and when she yawns, her tongue curls up, almost touching her right ear. I doubt it has much feeling on that side, so accounts for even more dribbling than usual after drinking water (but what labrador anywhere drinks neatly???) It isn't perfect, but at least she has a tongue, and that goofy sideways grin gives her even more character than the usual smiling, happy water dog that she is.

4 weeks is awfully young to wean a puppy from its momma, but this just wasn't a normal situation. We did our best choosing some pain medication for her, but were limited due to her age. It didn't seem to matter, though. She was up and eating that first night after surgery, and was carrying a frisbee that was bigger than her later that week. Eating and carrying something, Frisbee, tennis ball, stick-SOMETHING-have been THE themes of her life ever since! She was our first (and so far only) dog in the family, but not the first pet. Flake was our "top dog," even though she happened to be a Maine Coon cat. She was bigger than the puppy at the time, and even though not exactly thrilled with the new addition, handled her just fine. The curious puppy couldn't help bouncing up to the giant cat asking her to play, and came away more times than not with a swat on the nose but hardly humbled at all. To this day, Verbal goes up to the various kitties in her life a bit cautiously, fully expecting to get whacked, but unable to resist-she just loves them so much!

Since I brought this broken little thing home kind of unexpectedly, I thought it would be best if I let Michael name her. We had just seen a great movie, "The Usual Suspects," one of Michael's favorites, and the main character, played by Kevin Spacey, actually had two names. "Keyser Soze" just didn't seem like a good name for a little girl puppy, so "Verbal" it was. We kind of thought it would be a joke, too, since how could a puppy whose tongue was ripped off and jaw was broken be very talkative? Ha! The joke was on us! Verbal more than lived up to her name, and very few people who meet her know the source of her name-they just assume it is because of how darned much she likes to talk.

Since she had no trouble eating, she began growing like a weed. It was only two weeks before we realized that pin in her jaw would have to be removed. I took her to work, anesthetized her, and pulled the pin, but during her recovery, Verbal's heart stopped! I went into emergency doctor mode, performing CPR, injecting epinephrine into her heart, and sure enough, that plucky little puppy came back to us. I got the job of reviving her done-then went and puked my guts out. Being mom and doctor at the same time is really hard to cope with, but it was good to know that I could automatically go into emergency mode when needed-and deal with the emotions of the situation later. Verbal actually suffered hypoxia during her cardiac arrest. The lack of oxygen to her brain resulted in her being very wobbly and unsteady when walking for a few days-and scariest of all, she was actually blind for a day! Of course, we didn't know it would only be 24 hours, and it was a horrible time when we didn't know what was going to happen to her. Michael was adamant-we were NOT getting a seeing eye dog for our puppy! Thankfully, she regained her sight the next day, and gradually got more steady on her feet. An anesthesiologist I consulted with thought her blood glucose might have been too low during her procedure, resulting in the hypoxia. While adult or even older puppies can be safely fasted prior to anesthesia, it just isn't safe to do so in these neonates or very young puppies for just this reason. This was just one of so many things Verbal has since taught me about medical issues that I would be able to use for my future patients. I know she came into my life for a reason, making me a better veterinarian, despite what people say about how lucky she has been to have me (a vet) for her owner. She has given me far more in my life than I could ever have given her.

After that anesthesia fiasco, I swore I would make her suck it up and just stand there for her spay. Not really, but I sure was holding my breath during that surgery when she was about 6 months old. I think the anesthesiologist was right about that low blood sugar as a neonate-she has never had anesthetic complications again-and she has had a LOT of surgeries in her life.

Verbal was only about 2 months old when I began noticing how she ran with both of her hind legs kind-of "rabbit-hopping" together. Normal dogs have hind legs that move independently of each other; this rabbit-hopping gait was indicative of pain, discomfort, or at least some limitation of movement in her coxofemoral (hip) joints. We took some radiographs of her hips and found out that she had a terrible case of hip dysplasia. I probably blogged about it before, but where there should be nice deep sockets or cups, Verbal's hips had flat plates. There was no where for the round heads or balls of the femurs to fit. Her right side was much worse than the left, and unfortunately, surgery was in her very near future. I took her x-rays and visited a surgeon I respected and trusted. He told me that the "usual" surgery to repair hips in such a young dog, a TPLO or triple pelvic osteotomy (breaking the hip in three places and plating them together in alignment for the femoral heads to seat better) just wouldn't work because of her particular anatomy. We would have to wait and do at lest one if not two total hip replacements. Since these surgeries can't be done on growing dogs, and since she was already showing signs of pain, we decided to do an FHO or femoral head osteotomy on her right hip. This involved removing the ball and neck of the bone so it would no longer cause bone-to-bone contact and therefore no more pain. Read the blog on 3/24/09 about Quik and his screening for hip dysplasia for more info.

Her hip surgery went well, and so did her spay, thank goodness. She was pretty much pain free-and she went everywhere with me. I was so lucky! I had a small mobile (house and farm call) practice at the time, so she hopped in and out of the truck, waited patiently while I doctored any sick animals, and looked forward to getting on the way again. Well, there are a few things she isn't so "patient" and good about. When she sees cows, for example, she just has to let them know who's boss. She doesn't do this for any other animals, unless a dog is obviously challenging her, jumping up and growling at "her" car-then it is only natural that Verbal gives them a piece of her mind. She also loves to "attack" the scrubbers and brushes when we go through automatic car washes. I really don't think she is afraid or anything-I think it is a big game and she is just having fun. But boy! Those windows get all steamed up and drool-y by the time we are driving out the other side. Nice and clean on the outside-pretty much a disaster on the inside. Oh well, simple joys in life....

I said she went everywhere with me-she really did. When I was doing some relief work, working for other veterinarians at their hospitals or clinics when they were taking vacations or going out of town for some reason, Verbal would always come with me, even when we had to stay in motels. In fact, we became "regulars" at one motel. Verbal and I stayed in the same room on the top (3rd) floor. She would often wake up before I really needed to and wanted to go outside to do her business. I REALLY didn't want to get dressed just to do that and then come back to go to bed again, especially on those cold, rainy, wintery days. I would just open the door, Verbal would run down the three flights of stairs, run to the back of the motel, pee really quickly, and come running right back up to our room. What a good girl!

So, I mentioned that the FHO surgery went well and she had no pain in that hip. This was so evident that she put most of the weight on her hind legs on that leg, and subsequently, one day, playing Frisbee (of course) came down from way too high of a jump and blew out her anterior cruciate ligament (ACL) I've blogged often about ACL injuries-Verbal's was no different-except for the fact that she had surgery on her blown knee 3 times! It now has severe degenerative joint disease, an "end-stage knee" according to the orthopedists, and she will always have pain there. We manage it the best we can using multi-modal analgesia (again, a frequent blog topic) and of course, no more high flying Frisbee games. And now at her age, a couple of tosses and chewing some of the cheap Frisbees to shreds is just fine by her!

Swimming is such good exercise for bodies, human and animal, as it allows working muscle without too much stress on the joints. Now, our hospital is in a community called Lake Stevens-and yes, there is a nice lake here. But do you think we could find a place to swim anywhere on that lake? There are "no dogs allowed" on the public beaches, and I just didn't have any friends who owned property with beach access. I was reprimanded by a "lake cop" one day while walking Verbal on an empty beach; we were standing by some HUMAN'S discarded dirty diaper. I mean, gross. We always carried baggies for "accidents," but there is just no reasoning for some things. I decided to write a short letter to the editor of the Lake Stevens Journal, our local little paper, asking if anyone would be able to offer their yard access to my gimpy yellow dog who needed swimming for physical therapy. The response was just amazing! We have a terrific community of pet lovers, that is for sure! I got over 30 responses offering Verbal a place to come swim any time she'd like. I can't help but wonder how many I would have received if I had asked for a place to swim for myself-a gimpy HUMAN! Another story there....One wonderful lady named Jo actually called me the day BEFORE the paper was released. I was really surprised by this until I learned that she worked part time for the Journal, stuffing inserts in it before delivery the day before release each week. Jo lives alone, her husband had died and her children had moved away. She has a very cute home and a secluded back yard right on the water. Jo offered it up to Verbal and me any time we wanted to come over....She is so sweet, Verbal just adores her, and the little steps going down into the water are perfect for my gimpy old lady. She goes crazy when we are driving up to Jo's house-she can smell the water and it just makes her day! We never stay very long, and I always have to make sure I hose her off really well after the swim. Lots of duck poo and other fun things growing in the water usually give my disaster dog a lovely case of pyoderma (skin infection) if I fail to do that. I never knew a dog could wag her tail while swimming and retrieving. I wish I could take her to the lake every day-such a simple thing makes her so darned happy. It's the least I should do for her.

So, life went on pretty fine for Verbal, normal aging stuff, an occasional lipoma (fatty lump) but nothing too awful. Then came a day when I noticed she was chewing at one of those apparent lipomas on her elbow-she just wouldn't leave it alone. I was constantly telling her to stop it-anyone with an itchy dog knows the lip smacking sound-it can drive you crazy! Then the light goes off in my head-duh! That is what I have clients monitor lumps and bumps for....does the pet "care" it is there? Licking and chewing at a lump is a tell-tale sign that we should remove it, or at least biopsy the thing. Verbal had quite a few lumps at this point, and needed a bit of some dental work, so we went ahead and removed it and sent that elbow lump in to the lab for analysis. Wouldn't you know it? It wasn't just a lipoma, it was cancerous. In fact, it was a type of cancer, hemangiopericytoma, that is very aggressive where it occurs, so much so that the oncologists recommended amputating her leg to control the disease. Ugh.

I already mentioned her terrible hips and the blown apart knee; amputating a front leg would have just been cruel. So, removal of the mass and follow up radiation therapy at the tumor site was the best treatment choice for my Verbal.

I can't remember if I have blogged about radiation therapy in pets yet. If not, I'll go into more detail some other time-it is pretty fascinating! But suffice it to say that Verbal had her treatments-15 of them!-and was cancer-free for 3 years-pretty awesome! Then another tumor popped up at a different site on the side of her chest-totally unrelated to the first one. My girl is just a tumor factory. This one was able to be removed with a very radical surgical procedure, cutting wide and deep margins around it and having those margins evaluated for sneaky little cancer cells. The margins were deemed "clean" by the pathologist, and now, 1 year later, there is still no evidence of regrowth of that tumor, thank goodness. I watch her like a hawk, of course, and every lump or bump she gets is tested with an FNA (fine needle aspirate) while I hold my breath and pray.

Last week we did Verbal's yearly blood panel. I certainly had been noticing her change in eating and drinking habits over the last year-she has been ravenous! She practically takes your fingers off when you give her a treat, and, as gimpy as she is, has been finding ways to get up on the table and counters to scarf up food (especially the cat food) left there. She would drain her water bowl dry on a regular basis, and even raid the toilet for more water. These were behaviors she had never done when she was younger, and I was oblivious, attributing them to being a bad old lady dog, losing her manners or something. Well, the bloodwork showed that she has a very specific reason for these changed behaviors- Verbal has hyperadrenocorticism, or Cushing's Disease. Dang! What more does this sweet thing need to deal with???

I'll blog specifically about Cushing's later on, but basically it is an endocrine (hormonal) disease, caused by too much cortisol in the body. It can occur for various reasons-Verbal's is caused by a tumor on her pituitary gland triggering her adrenal glands to produce too much of this hormone. Cortisol mimics stress in the body, and we all know how much havoc stress can play on our bodies. I guess it is good because we have an answer to why Verbal is behaving the way she is, and can now go about the process of getting her treated for it. As with so many diseases, Cushing's cannot be cured; it will be a condition we have to manage for the rest of her life. Monitoring that treatment is particularly important because over-treatment can be very dangerous; hypoadrenocorticism or LOW amounts of cortisol in the body is Addison's Disease and can result in weakness, collapse, shock or even death.

Whew! That was some blogging I did there, huh? Can you tell Verbal is a "subject" I feel passionate about??? I love that dog, and was just talking the other day with my friend, Valerie, about this very thing. Some times we are lucky enough to have one special dog in our lives, our "heart dog," the love of our life-however you refer to the relationship, if you are fortunate enough to experience it, you just know what I am refering to. This new diagnosis of Cushing's Disease is awful, but we will fight it as we have every other battle in her life. She hasn't stopped wagging her tail, smiling, and just generally goofing around. I saw her upside down, rolling back and forth in the newly cut lawn on Sunday, just reveling in the feel and smells and all. You make what you will of life, and Verbal sure has made hers full and happy, despite all the challenges along the way. Yep, she has taught me so very, very much. I love you, Verbal dog.
Peace,
DrReneigh

Max Can't Catch His Breath

2009-07-17T14:17:00.000-07:00

Max is normally a goofy, joyous Labrador, (are there any other kind?) always so happy to visit us for whatever reason-vaccines, ear infections, even getting neutered-you name it. He was always jumping and wiggly and just full of energy. But last week when he came in, things were markedly different for poor Max. He was struggling with something we all take for granted-Max couldn't breathe! Well, not without extreme effort on his part, any ways. He was panting, extending his neck, and just couldn't get comfortable. His owner reported that he couldn't lie down for any period of time and therefore hadn't slept in days. She and her family had actually been gone the week prior and Max had been looked after by a friend during that time. That friend noticed the problem developing towards the end of his stay, but couldn't pinpoint exactly when it started and couldn't tell us what might have triggered it. We were concerned that this could actually become a life-threatening issue, so we worked to get to the bottom of just what was causing the condition known medically as "dyspnea"-literally abnormal breaths.

Max didn't want to leave his owner's side, but we worked gently with him and encouraged him to allow us to work with him. Usually treats would have been welcome, but Max didn't want anything to do with food-it was all he could do just to get air in and out of his body. We had to figure out if this was because of an obstruction in his throat or airway, an infection in his lungs such as pneumonia, or if the dyspnea was secondary to some other condition. Pain and fear often cause our patients to stress so badly as to cause panting when we see them, but Max was having these breathing difficulties at home, too, where presumably he wasn't stressed. Pain was still possible, so we set out to find a possible source of that.

Max's blood work was perfectly normal-surprising since he hadn't eaten in so long. I expected at least some electrolyte abnormalities, but even they were just fine. We did find, though, that whenever we worked with him, Max became cyanotic-his tongue and gums became a distinctly blue or purple color due to the lack of oxygen traveling through those tissues, a very scary finding. We placed a mask over his nose and delivered oxygen to him-he didn't like the smell of that very much, but he evidently liked how it made him feel and he stopped resisting the mask pretty quickly when he realized it meant he could actually breathe with it around.

Next we put Max on the x-ray table and got some radiographs of his chest. It was difficult to get good films because he just couldn't lie in the positions required for very long at all. His blue tongue and distressed/panicked demeanor had us rush the process, but the diagnosis became evident despite the less than ideal positioning. Max had developed a pneumothorax.

Pneumothorax is free air in the space in the chest outside and around the lungs. It may result from trauma to the chest as when ribs become broken when animals are hit by a car, for example. We also see pnemothorax in patients who develop excessive pressure on their lungs, therby overinflating the lungs and rupturing the little alveoli or air sacs of the lungs. Underlying lung disease (asthma, chronic obstructive pulmonary disease, etc.) can also cause pneumothorax, again because the alveoli are damaged and air leaks out of them into the thorax. In some cases, we never do find out the cause of the pneumothorax-that is very frustrating because then we don't know if this will be something that will reoccur (and therefore how we might prevent it.) The problem with pneumothorax is that the air surrounding the lungs doesn’t allow the lungs to inflate normally, so dogs and cats with this condition can have difficulty breathing (the dyspnea we saw in Max), increased respiratory rate, exercise intolerance, chest pain, cyanosis, collapsed lungs, etc. If only a tiny bit of air gets inside the chest cavity, it can be resorbed and the pet can heal without medical help. If there is a lot of air in the chest cavity, however, it must be removed medically. If severe cases are left untreated, or it is progressive as happens with big holes in the chest, the pneumothorax can be fatal.

Max's chest was FULL of air-this was a pretty severe case of pneumothorax, but it did not appear to be progressing rapidly. If it had, he likely wouldn't have still been alive. We searched teh x-rays to find a cause for the free air in his chest cavity. There were no obvious broken bones or other evidence of trauma. We certainly would have hoped his dog-sitters would have told us if he had been hit by a car or had experienced some other massive trauma or had been exposed to any toxins or the like. His blood work hadn't indicated any raging infections as a possible cause, and we didn't see this on the radiographs, either. We were facing an unknown cause of his condition, but at least we knew how to help him. We had to take the air surrounding his lungs out of his chest, and we could do this with a long needle and a great big syringe. Some patients require the palcement of an indwelling valved chest tube, allowing for the continued evacuation of the free air while the patient's body heals from whatever condition caused the air leakage or production in the first place. My biggest concern was that after evacuating Max's chest of all that free air, what would prevent it from coming right back? We just would have to wait and see and hope that it was a one time thing and that his otherwise young and healthy body would be able to heal.

The process of inserting a needle into the chest in order to aspirate and remove the free air is called thoracocentesis. It is important that anytime you insert a needle into the chest cavity that you don't inadvertantly introduce bacteria into it, so we did a surgical prep of Max's skin over his rib cage on both sides of his chest. This involved clipping the hair off and scrubbing the skin with an antimicrobial solution. We inserted a needle into his chest, attached some tubing and a syringe, and pulled some air off his chest-and continued to do this over and over and over for well over an hour. we finally got negative pressure on the syringe after almost 10,000 mls of free air was drawn off the left side of his chest and another 1000 mls was taken off his right side. I suspect the two sides were communicating with each other and the "little" extra taken off the second side was just found in a pocket there, but regardless, it was an impressive volume-over 2 1/2 gallons of air where it shouldn't have been!

It was pretty darned cool to watch Max during his thoracocentesis procedure. Initially, it was very difficult for him to sit still for us; there just wasn't any position where he was comfortable and he became cyanotic very frequently from stuggling/panicking. He required oxygen by the face mask, but we had to just keep forging ahead. As more and more air was removed, Max became visibly more comfortable. At first, we noticed he was simply breathing through his nose; he was no longer open-mouthed breathing or panting. Then he became more and more relaxed to the point he rested his head in his nurse's lap, sighing deeply, and even shutting his eyes a bit. He was exhausted, the poor thing, and relieving the air gave him the freedom to stop struggling and just rest. We all felt so good for him.

We never did find out the cause of Max's pneumothorax, but he was lucky. We sent him home and over night and through the next day, there was no evidence that the pneumothorax was returning. We never did have to place a chest tube, but we did put him on some antibiotics and some antiinflammatory medications. We had Max come in that next day and we listened to his chest, but you could just tell by looking at his face and reading his demeanor that he was back to his happy, rested self-no longer preoccupied with where his next breath was going to come from. His owners were please and very relieved, and it looked like they were able to finally get some sleep, too. Breathing is a good thing.

Peace,
DrReneigh

Kitties Aren't Supposed To Be Yellow

2009-06-05T12:08:00.000-07:00

So when Snaps came to see us and we saw the very bright discoloration of her skin, gums, ears-even what should have been the "whites" of her eyes, well, we knew there was something serious going on.

Her owners said Snaps just wasn't herself. She had vomited a few times, but really wasn't eating well and the once very obese cat now just looked moderately overweight-a very dramatic and rapid weight loss for her. Her owners knew something was wrong, but hadn't realized their kitty was practically glowing in the dark.

Jaundice or icterus is the name of this whole body yellowing, resulting from a yellow pigment, bilirubin, normally kept in check by the liver. Diseases of the liver, of course, can result in this icterus, but so can primary diseases of the biliary system itself-the gall bladder or bile ducts. Other less common causes include hemolytic anemias, where red blood cells are destroyed, often by the body's own immune system. Snap's blood tests led us in the direction of her gall bladder-her liver and red blood cells seemed to be just fine.

You have probably heard of bile ducts but may not really be sure what bile is all about. Bile is a greenish material the liver makes, then transports to the gall bladder via small bile ducts. The gall bladder is a small greenish sac about the size of a large cherry in a cat where bile is stored. When the appropriate hormonal signals are present, the gall bladder contracts and squirts bile into the small intestine via one very large duct called the common bile duct.

Bile has several functions. It emulsifies the fat in our diets so that we can absorb it into our bodies. It also serves as a medium to dump toxins that the liver has removed and processed from our bodies. Mixed and bonded in bile salts, these cannot be reabsorbed from the intestine back into the body and are harmlessly excreted in feces.

Diseases of the gall bladder can be infectious, usually bacterial or neoplastic (cancerous) especially in older patients. We also see mechanical problems with the biliary system-sludging or thickening of the contents (bile) or even gall stones blocking passage of the bile through the bile ducts. These can be very painful conditions, and often cause anorexia because every time the patient goes to eat the gall bladder contracts to empty its contents into the small intestine to aid in digestion. If there is a blockage or infection/inflammation, contraction produces pain- the cat will associate eating with pain, so will simply stop eating to avoid that pain.

Now, one would think that weight loss in an obese cat would be a good thing. But cats are difficult creatures, for sure. As obligate carnivores, they require protein daily. If they aren't ingesting it, they will find it somewhere-even utilizing their own liver tissue as a source of that protein. The body will use the liver cells and replace these hepatocytes with adipose or fat cells causing a very serious condition called hepatic lipidosis or "fatty liver disease." Sometimes this is actually the primary disease, but usually there is some reason that the cat stopped eating well.

Since Snaps was essentially starving herself, we anesthetized her and placed a stomach feeding tube. This made it much easier for us and her owners to syringe feed her calculated needed calories each day (rather than trying to do so by mouth and having more of the food end up ON her rather than IN her!) It was also a good way to give her medications-just mixing those pills and capsules with liquids and foods and putting them directly in the tube rather than fighting her for that, too. We prescribed a long course of antibiotics and antimicrobials as well as anti-nausea medication and pain relief drugs. She was also given a whole bunch of fluids under her skin to help start flushing her liver of those built up toxins and pigments. Snaps was also started on a type of medication known as a "cholorectic." Ursodiol or actigal is this medication that makes bile more liquid so that it can flow smoothly without sludging. Flow of bile in the proper direction helps remove not only the toxins the liver is trying to remove in bile but also helps prevent bacteria from swimming upstream towards the liver tissue. We were hoping that her bile ducts were not actually blocked or that Snaps did not have gall stones present as cholorectic drugs would not work for these issues-surgery would be her only option in those cases.

So, Snaps was sent home with a whole lot of nursing care expected of her very devoted owners. They did a fabulous job with her-at one point it even looked like she was less jaundiced and had even gained some weight. But Snaps never did begin eating on her own, and it wasn't long before she began to vomit the food her owners gave in the tube if they tried to give any more than just a minimal amount. It wasn't enough to maintain her weight any longer, and she started getting more yellow by the day. She was licking her lips and acting nauseous if she even saw her owners approach her with food. I strongly suspected a biliary duct blockage or gallstones, but would need an ultrasound exam to be sure.

We referred Snaps' owners to a veterinary internal medicine specialist for that procedure. Unfortunately, their costs were estimated to be quite high, as was to be expected of such a specialized procedure with biopsies and lab reports involved. I had scanned many abdomens but was far from an expert, so offered my services for free just to visualize the gall bladder and liver only and determine the presence or absence of gallstones or big dilated biliray ducts-signs indicating likely blockages. Snaps' owners were very grateful, and it did give me more experience with this procedure.

Well, the ultrasound scan was pretty quick and easy-a homogenic (even throughout) liver-no obvious masses or other defects with a very large gall bladder and hyperechoic (very bright white) structures in the lumen. (center) Snaps has gallstones. No amount of medications will fix these-she has to have surgery to relieve the pain felt every time the organ contracts down on those stones each time she eats (or is tube fed for that matter.) What a horrible situation that must be-to be in pain just because of a basic need and a generally pleasurable function-eating.

We have talked with her owners and will try to come up with a plan for her. While referral to a veterinary surgeon is highly recommended for a cholocystectomy, (gall bladder removal) money of course is a big factor. We might be able to use some funds from our Flake's Angel Fund if the owner can match those funds and attempt to do this surgery ourselves. I have done a few others-it is a very difficult surgery but am hoping to get some tips for better visualization (I have found this to be the key to this surgery) from the veterinary surgeons we work with. They are very helpful that way.

Snaps' owners are saving up their money deciding what they want to do (and what they are able to do.) In the mean time they will continue to try to get food into her, even if it is just small amounts very frequently. Her liver medications aren't as important, but her pain relief meds certainly are.

I'll try to post some pictures of her surgery when/if we get to do it. She is a great kitty and she has very nice owners who are doing a great job with her care. Not all owners would be this devoted, that's for sure.

I felt so bad neglecting my blog this long-it is good to be back!

Peace,
DrReneigh

A Dream Come True

2009-05-18T15:13:00.000-07:00

Literally. Ever since I was very young, whenever we would go camping or backpacking and I would see the tell-tale hoof prints of the horses who had traveled along that trail, I imagined and dreamed of one day being the lucky one camping with her horse. And seeing horses galloping on the beach-ah, so majestic and beautiful. I have been a beach lifeguard and a lifelong sun worshiper. I have had opportunities to ride on a beach with rental horses in Mexico and on the central California coast, but never with my own horse. That is, until last weekend. I joined a group on Meetup.com of fellow horse lovers, and due to the generosity of some folks who offered to haul my big horse, took off a couple days (which I NEVER do!) and went to the Oregon coast to go horse camping! We planned for months (having to reserve space for 40 people and horses) and I almost died when my mare came up lame the night before the trip (could only happen to a vet's horse, right?) She got a stone bruise but a little iodine, bute and lots of adrenalin (and a gigantic epsom salt soak in that ocean!) and she was good to go... but not after I said a hundred prayers and cried myself to sleep. Well, the weather was perfect, she never limped a single step, the people were fun, and, well, the pictures say it all. I got to go camping with and ride MY gorgeous horse on the beach-and made it before I turned 50!

I was originally supposed to go with a fellow horsey friend, but she backed out a couple of weeks ago. I still had to go, of course, but was thinking it wouldn't be as much fun not really knowing anyone. When my other friend, Happy, heard I was going alone, she casually invited herself to come along-and boy am I glad she did! She is totally un-horsey, in fact, she has never even rode a horse in her life. But she was my biggest cheerleader-really understanding what this weekend meant to me and being a true friend in every sense of the word. She helped out planning our meals and shopping before hand for gear and supplies. Happy was a great companion for the long road trip, putting up with my choice of "old man rock" music and just gabbing with me during the drive. Once we arrived at the campground, she helped so much setting up the tent and kitchen stuff and all while I got Raquel all situated. And boy did she take some great pictures! I don't have many of her, darn it, since she was the one behind the camera lens, but I will never forget all she did for me and Raquel during our adventure.

Raquel settled into her camp stall just fine. I had been a bit worried that she would power through the chain gate (we have electric fences at home for just that reason) but putting a constant supply of hay in front of her (and keeping her good and tired from all the beach rides) did the trick. Our organizer had recommended to bring one of those pop up canopies to put over the stall so the horses wouldn't have to stand in the direct sun all day (or pouring rain if that was the case.) The horse camp sites were so much better than the regular sites. We had a lot more privacy, not just parked right on top of each other. It was still early in the season so it wasn't crowded at all, but I bet it can get pretty packed in the middle of summer.

A group of us decided to walk our horses out to the beach on foot that first evening-just to give them a "taste" of the salt air, all the sights and sounds and smells and all. I'm glad we did. Raquel was snorting and prancing and dancing-everything was new and exciting. Happy's pictures sure captured the moment. Later on we joined the bigger group for a potluck supper and get-together. Good food and good company. Happy even found that she knew some of the folks from high school if you can believe that! Such a small world. We were pretty tired from all the excitement of a very full day, so turned in soon after dark.

Friday morning we woke up early-well, I don't think Happy and I slept much, actually. We had left the tent flap open a bit and ended up getting pretty wet and cold from all the dew and condensation. It just felt better to get out of the wet sleeping bags and get some hot coffee into us. And I was just itching for that first ride on the beach! I decided to give Raquel some bute (phenylbutazone, a nonsteroidal antiinflammatory drug) for a bit of swelling in the fetlock of the leg with the bruised hoof. That went over well-NOT! She knows just how tall she is, and how short I am! Oh well, she got the meds after a little fight, then off to the beach we went. I went out with a sweet lady named Deb and her older horse, Todd. She wanted to take it slow and easy-just right for our first time. I didn't need a rodeo! We rode over the dunes and out onto the beach and there we were! It was incredible. Raquel continued to dance and prance as she took in all the smells and the sounds of the waves and all. It took awhile, but she eventually splashed through the water when she figured out it wouldn't eat horses. After I felt she had most of the bugs out of her system, we went ahead and took our first run on the beach. What a feeling that was! She never took a lame step, we had the wind in our hair and sun on our faces. Back home Raquel is usually last on trail rides with me legging her on-not on the beach. There she was always wanting to be in the lead, fighting the bit to go, go, go! I think she felt so much more sure of herself there, more balanced where she didn't have to worry about turning every 2 or 3 strides as she does in the arena back home. It filled my heart to see her having so much fun.

My sister Kristine and her partner Kelly had just had their first baby a week before this trip. Since they live in Oregon, I thought I would take the opportunity to go visit since I was so close. I asked my camp neighbors to peek in on Raquel through the day if they could, making sure she had food and water and off we went. Well, it wasn't all that close, what with windy roads, a bad accident on one highway, and Friday afternoon commuter traffic. But I am so glad Happy and I made the trek. Little Aven is just beautiful, and Kristine and Kelly are terrific mommas. The visit was much too short, but I didn't want to leave Raquel alone for too long. I'll get down again soon, I hope.

Happy and I figured out the sleeping/tent situation that night and were much drier and warmer. We both slept better and woke to another glorious day. I rode out again with a bigger group and Happy enjoyed herself sunbathing and just relaxing as she deserved to do. Then we had a great surprise when my husband Michael and Verbal showed up that afternoon! Nobody enjoyed the water and sand as much as my goofy yellow dog.

I got Michael out to the beach and up on Raquel-and he had a great time! He doesn't ride much, but he felt so much more comfortable on her and was soon galloping down the beach like a pro.

You would think that was a full enough day, but no. One of our meetup members, Phil, is very involved with jousting and he brought his authentic suit of armor ( he said it weighs about 100 pounds!) and costume for his horse. Now, isn't a knight in shining armor exactly what dreams are made of?

We had another dry, warm night, time for a quick ride on the beach Sunday morning, then packed up and headed home. It was over much too quickly, but I know Raquel was exhausted even though she would have gone on forever. I'll never forget this trip and all the people who made my dream possible. My terrific staff and our relief doctor took great care of my patients and clients while I was away. Happy was a true friend-what more can I say about that? Michael surprised us by bringing Verbal and joining us for the weekend. And the wonderful meetup group who suggested the trip, made recommendations of what to bring for us newbies at horse camping, and Michelle and John for hauling my big horse all the way down to the Oregon coast. Dreams really do come true.

Peace,
DrReneigh

Telling Time Without A Watch

2009-04-30T11:50:00.000-07:00

We were nearing the end of another busy day at the hospital. Dirty towels and surgical drapes were piled high in the laundry basket. Some instruments were soaking in the bucket of disinfectant and others were finishing up in the autoclave, getting sterilized for tomorrows procedures. Patient charts were seperated into different piles, some for the nurses to make follow up calls, others for me to complete writing my medical notes and plans for patinet care. But one of the tell-tale signs that the day was coming to a close was the presence of Noodles and Twitchi, our hopsital cats. Without fail, every evening starting around 4:30 or 5, they make there way out from where ever they had been hanging out, usually working pretty hard, sleeping on a cat post or in one of the receptionist's chairs. Then they oh so patiently just sit-and stare-and wait. It is kind of creepy, actually, like the gathering of the birds in Alfred Hitchcocks movie. There is no mistaking what they want-come on humans-don't forget us (as if we ever have!) It is dinner time!

Anyone who has ever had a pet knows that they can tell time-no watch or clock needed.
We can say they have a "biological clock" or an "internal clock." It actually is an anatomical site within the animal's hypothalamus, an area of the brain directly above the place where the optic nerves cross. Composed of about 20,000 neurons, this area is known as the suprachiasmatic (above the cross) nucleus. It takes in variations in the available light from the retina, (the structure at the back of the eye) then transmits this information to the pineal gland. The pineal gland is a small, cone-shaped organ in the brain of most vertebrates that secretes the hormone melatonin. It is also called epiphysis, or pineal body.

There is a complex process allowing this transmission. Genes are encoding proteins and these genes will then regulate the functions of the cells of the pinel gland. This is when the cells start secreting the melatonin hormone. Once in the bloodstream, melatonin peaks in the daylight hours and ebbs at night causing wakefulness and sleepiness.

The circadian system is the total of all these neurons, their cells and the proteins and hormones they secrete. The system is not dependent on light and dark cycles, however. That is why animals can re-set their internal clocks as long as the new pattern is fairly regular and sufficiently important. In the case of Noodles and Twitchi-putting food in their bowls is plenty important!

Dogs and cats aren't the only ones who have these internal clocks. Species as diverse as fruit flies, humans and birds have circadian rythyms, and they don't have to be exactly one day long. (In Latin, "circadian" means "approximately one day.") Two examples are the heat cycles of domestic dogs, which usually occur about twice a year, and the menstral cycles of human females occuring approximately every 28 days.

So tomorrow night when your critters start circling up in the kitchen or come over and lay down near their food dish-raising those expressive eyebrows at you (as if you really don't know what they could want-we are dumb humans after all) , remember how complex a thing this circadian rythym process really is-and why when Noodles and Twitchi get ready to "retire" from their very busy jobs here, they probably don't need that gold watch. They do just fine with their internal clocks.

Peace,
DrReneigh

Jesse is Being an Ass

2009-04-21T14:03:00.000-07:00

If it isn't one thing, it's certainly another-that sure is true around my house, what with all the critters we have. From pulling Stella out from under the bed to give her asthma medications, to making sure Verbal gets her arthritis drugs and supplements every day, and more recently chasing a ticked-off rooster so I can dose him with some pain meds-gee, what more do I need to medicate? I shouldn't have asked that question. Can anyone say limping donkey?

Yep, Jesse, my very furry, long-eared donkey is very lame, barely putting any weight on his left hind leg. I am pretty sure it is due to an abscess in his hoof-he seems to get one every year. Donkeys or burros are supposed to have really tough, hardy feet. Well, I don't know if it is all the mud we have (really not too bad considering all the rain here) or the rocks, his particular conformation or what, but Jesse's feet are just prone to these infections that occur within the hoof.

A hoof abscess can be defined as a localized accumulation of purulent exudates (pus) located between the germinal and keratinized layers of the epithelium (hoof capsule), most commonly subsolar or submural. I have seen these occur in horses secondary to nails from shoeing, but Jesse has never had shoes on his feet, and the last trimming he had done was over a month ago. Of course, the same thing can happen if a horse is punctures by a nail or other sharp object. Other abscesses occur after a deep bruise to the sole, usually from a stone wedged in the sulcus or groove adjacent to the frog tissue. The frog is the softer triangular wedge of tissue that acts as a pump in an equine leg. Often referred to as an additional heart, the 4 frogs (one in each foot) help the circulatory system, literally pumping blood back up those long legs to the lungs so it will get oxygenated again. Breakdown at the junction between the sole and wall as happens in white line disease or a simple crack in a hoof wall can predispose a foot to abscessation.

Understanding how an abscess forms can help in the understanding of how to best treat the often very painful condition. Bacteria will enter at the puncture, bruise, nail hole or white line defect, usually at the sole-wall junction at any point around the foot. As the horse walks and puts weight on the foot, dirt and other foreign matter push into the tract made by the bacteria. Once inside the hoof, the body's defense mechanism sets off a reaction called inflammation-this is ultimately what causes the heat, swelling and pain. The bacteria continue to grow in this environment, and white blood cells migrate to the area to help fight the infection.

Enzymes are released from the bacteria and this causes the hoof tissue to melt or liquify, turning into the blackish/gray "goo" associated with abscesses. The body tries to wall this off with a thin capsule, forming the abscess capsule. It can get very tight as the bacteria continue to reproduce within, resulting in more inflammation and thus more pain. It usually only takes about 3 to 5 days from the initial "insult" for clinical signs to occur, so if your farrier accidentally misplaces a nail or your horse (or donkey) gets a puncture from some other cause, treating with an antiseptic for a few days might ward this off. Of course, we often never know about the puncture or bruise that caused the abscess, as in Jesse's case. If I had, I would have loved to have prevented this apparent excruciating pain-and my need to fight with yet another of my own own butthead patients.

Jesse lets me know he has an abscess by showing up extremely lame in the affected foot. The lameness can be pretty sudden as his tend to be, and can vary from subtle early on to non-weight bearing as the condition progresses. It is often possible to palpate a digital pulse near the fetlock, stronger on the side of the foot where the abscess is located. Overall, the affected foot is usually warmer due to the inflammation, and if long-standing, the entire pastern or fetlock may become swollen from the disease or from disuse. We often use hoof testers to locate exactly where the abscess is, although some horses are sensitive in the entire foot making you need to rule out laminitis or founder, a severe bruise or even a fracture of P-3, the coffin bone itself.

Treating hoof abscesses requires first and foremost good drainage. An opening should be made that is big enough to allow good drainage and won't heal closed too quickly, but also won't be so big that it causes more problems. Under no circumstances should an abscess be approached through the sole. Dirt and manure and other foreign matter will just pack into a solar drainage hole, making it ineffective or even worsen the condition.

When an abscess is localized with the hoof testers, a small tract is often found in the sole-wall (white line) junction. If it is not visible or has closed up already, a poultice can be applied in an attempt to soften the area and break it open again. Animalintex, available at feed stores or veterinary supply stores, is a great product, as are epsom salt soaked sponges. Full foot soaks, once the norm for so many foot conditions, are now discouraged as they can really soften and weaken the integrity of the hoof wall.

The drainage tract is followed within the white line using a thin small loop knife, a 2 mm bone curette or other suitable probe. Gray/black pus is the reached when the "belly" of the abscess is reached and this area is cored out carefully.

A small opening is all that is necessary to obtain proper drainage. This can be determined by placing thumb pressure on the solar side of the tract and observing more drainage being expressed or a bubble at the opening when pressure is applied. Care should be taken to avoid exposing any corium, as it will invariably prolapse through the opening, prevent closure of the tract and create an ongoing source of pain.

The draining tract should be kept soft and drainage promoted. The application of an Animalintex or epsom salt poultice that has been soaked in hot water can be applied for the first 24 to 48 hours. The whole foot, including the coronet band, should be incorporated into the poultice for best results.

The relief is usually pretty immediate. Once the pressure is relieved, most animals will bear weight again, and if the infection is controlled, all lameness should be resolved in just a few days. It is often best to keep the foot bandaged to prevent the introduction of more bacteria and debris into the newly opened drainage site, and antibacterial dressings can be applied to help speed up the healing. Betadine or iodine solutions are effective and inexpensive.

I rarely put these patients on systemic antibiotics as it was mentioned above that these infections are usually walled off from the body and therefore inaccessible to the bloodstream. Pain relief medication such as phenylbutazone is very welcome, however. Jesse, of course, hates his bute, even the apple-flavored paste, and isn't making this process very easy. Be sure tetanus vaccinations are up to date as the tetanus organism thrives in soil and would love this type of wound.

Some people actually allow abscesses to "run their course," allowing the infections to follow the path of least resistance and eventually rupture up and out at the coronet band. This seems like a cruel thing to do, making an animal wait in extreme pain for this process to occur, and it can leave the hoof much weaker and prone to repeated abscesses in the future.

So, today after work, my terrific horse shoer, Fred, came over and helped me wrestle with my problem child. Jesse really does love most people, but he and Fred have always had a bit of a love/hate relationship. Fred doesn't take any of Jesse's shenanigans, one time even trimming his feet laying down when Jesse threw a fit and decided to fall down to the ground in protest. He has since learned it doesn't do a darned bit of good; Fred will win every time, darn it!

Jesse was in fine form tonight, though, and oh so quick with that sore hind foot. While Fred got ready with the hoof knife and nippers, I got out the drugs. It was no fun finding a vein in which to give his drug through all that winter hair of his, and he proved just as stubborn metabolically-his drug dose probably would have stopped an elephant but Jesse barely hung his head. It was enough for Fred to quickly cut into that hoof, find the abscess and provide some good drainage before Jesse decided he had enough and found his aim again. He could barely walk-he looked like quite the drunk donkey-but I wouldn't have trusted that back foot one iota. I snuck some bute between his lips much to his chagrin and let him stagger off to commiserate with Raquel. He's going to be just fine.

Prevention of hoof abscesses is achieved through proper hoof care and centers on promoting a strong, solid sole-wall junction (white line) that resists penetration by debris. Hoof abscesses are less likely to occur when a solid sole-wall junction (white line) is maintained.

Excessive toe length increases the bending force exerted on the toe, leading to a widening and weakening of the white line. Other conditions that cause mechanical breaks or weakness in the continuity of the white line are hoof capsule distortions (long toe-under run heels, excessive toe length, heels too high or a club foot, sheared heels), hoof wall separations (white line disease, seedy toe) and chronic laminitis. Excessive moisture or dryness, and the extreme back and forth from one season to the next, may also contribute to weakness in the white line. I really think this is Jesse's problem, as we do a pretty good job keeping his feet trimmed and he has never had white line disease, laminitis or any of the other hoof pathologies mentioned.

So, thanks to Fred, Jesse is all doctored up for the evening. I chased down Viggo and pulled off that last straggling bandaid from his surgical site. It is healing well and he is crowing and herding his ladies in the yard-I think he is doing well, too. Verbal got her dinner with her medications for arthritis mixed in. And I just popped Stella her prednisolone tablet to help calm her inflammed airways until her inhaler arrives later this week. Whew! It feels like a vet hospital around here. It's a darned good thing that Bill the emu is healthy-I better knock on wood!

Peace,
DrReneigh

Viggo Can't Help Being a Boy

2009-04-17T11:58:00.000-07:00

Poor Viggo. He's just being a boy, and after all, that's what he is. But boy + chicken = ROOSTER, and when that is accompanied by an attitude that won't quit, well, something has to change. He is a handsome thing-and he certainly knows it. We have a whole slew of chickens, his little band of girls, and I'm not sure if he thinks he is protecting the ladies or if he is just being a butt head (much more likely) but he has started attacking us lately-and it hurts! Viggo hurls himself up and slams his 6+ pounds against your thigh or whever he can contact-and then he rakes his evil spurs against you. The spurs are actually bony appendages on the legs of roosters. They are very sharp, and yes, they sure can do some damage. I had a bruise that lasted for a week after his last unexpected attack. I'm getting pretty good about watching for him now, and (don't tell the animal cops!) he has received a few well placed kicks in the hind end when he was caught flying towards me. I even bring Verbal with me when I go to feed the chickens-she loves to chase them and her favorite sport is tumbling them head over heels (do chickens have heels?) as they squak and flutter. She has never attacked or hurt one-she just loves the chase and I'm sure she likes the noise they make. But Viggo doesn't back down, from me or from Verbal, and I'm afraid he is going to hurt her or maybe some unsuspecting visitor to my little farm one day.

So today our hospital sounds like a barnyard at 4 am-a very perturbed rooster is crowing at the top of his lungs-and won't shut up! Clients this morning have a very puzzled look on their faces, and everyone has smiled when we told them yes, we treat roosters, too, not just cats and dogs at this hospital. Noodles and Twitchy, our hospital cats, are just fascinated with this giant bird. They know they are supposed to be the predators, but Viggo stands taller than them and that voice-wow. Twitchy, especially, is going to need some time to get used to this.

The plan for Viggo was simple. We were going to place a mask over his beak and administer a gas anesthetic and oxygen mixture. Birds usually fall asleep very quickly with little struggle due to their very rapid metabolism. They generally have large tracheas, so we should be able to place an endotracheal tube for better anesthetic safety. We'll monitor him as we do any patient, and maintaining body heat is particularly important. Then I'll basically amputate those spurs or extra "toes." I had asked an avian specialist about this procedure and he said there shouldn't be much bleeding, but I could place some light wraps for a day or so if there was. He told me meloxicam would be fine for post-op pain relief and gave me some doses appropriate for a mature rooster. I'm not looking forward to chasing down that darned bird every day to stuff meds down his throat, but I will if I have to. Oh joy.

Here is Viggo getting his pain meds. He was a good boy for his medications, so maybe it won't be such a chore after all.

Well, the procedure itself was pretty quick, but I don't know what the specialist was talking about-those spurs bled like a son of a gun! I had to place some pretty tight little wraps over the surgery sites to get the blood to stop. Viggo started to pick at the wraps when he woke up and was kind of dancing a bit-I felt like the pain medication wasn't enough for him, so gave him an extra dose. That seemed to do the trick-he stopped dancing in his kennel and left the wraps alone after that. Pain control is important for all of us, even roosters.

So, we'll see how this goes. Taking away his weapons should at least make us safer around the barn yard, but maybe it will humble that cock-o'-the-walk, too. I can hope!

One other funny thing happened as a result of Viggo being in the hospital today. A sweet patient named Roarie, here for her own surgery and recovering in the cage right next to Viggo, was barking and howling and basically calling back and forth to him all day. It really sounded like she was trying to crow just like he was! Her owners were great about it, laughing when they heard her as they came to pick her up. I sure hope they are still laughing when she starts crowing at the 4 am wake-up call!

Peace,
DrReneigh

No More Tears for Tucker

2009-04-10T11:57:00.000-07:00

Tucker is a bouncy, happy Springer Spaniel puppy that didn't actually look very happy before his surgery yesterday. ( I didn't get a picture before surgery, darn it. I'll try to remember when he comes in for his suture removal.) He was constantly tearing or crying in one eye-and certainly not because he had anything to be sad about. This puppy has great owners and when we pointed out the tears during his physical exam last month, they promised to watch the eye and note any changes. I showed them how Tucker's lower eyelid was rolling inward, a painful condition called entropion, which causes the eyelashes along the border of the lid to constantly rub on the sensitive cornea of the eye.

Entropion can have a genetic cause, and Springers are one of the breeds predisposed to the condition. Other breeds commonly affected are Boxer, Bull Mastiff, Cavalier King Charles Spaniel, Chesapeake Bay Retriever, Cocker Spaniel, English bulldog, Golden Retriever, Great Dane, Irish Setter, Labrador Retriever, Poodle, Pug, and St. Bernard. Chow Chows and Shar Peis have all those extra wrinkles in the skin, so they can have very severe forms of the condition, and left untreated, entropion can cause painful ulcers and erosions on the cornea that results in scarring and affects vision. Those pets with the heritable form of entropion should not be used for breeding. Entropion can also occur as a secondary condition resulting from scarring of the eyelid, infection, corneal spasms and pain, trauma, or nerve damage. Sometimes it happens after the eyelids lose their normal neurologic function.

Tucker was fortunate because only one lower lid was affected-entropion can often affect both eyes and both upper and lower lids. When we examined his eye, we applied a stain called fluorescein on his cornea. If there had been any defect on his cornea such as an ulceration from chronic eyelash rubbing, the stain would have glowed bright green when a black light was shown on the eye. Tucker's cornea was fine so far, so correction of the eyelid malformation should prevent that damage and subsequent pain.

Surgery is the only way entropion can be permanently corrected-essentially plastic surgery for dogs, although it is not an elective or cosmetic procedure. The hair is surgically clipped around the eye and the skin is scrubbed, protecting the delicate eye tissue. Then the excess skin is "pinched" between several hemostats, taking gradually bigger bites until the eyelid everts or rolls outward to a more normal position. We don't want to incorporate too much skin in the hemostats or we can cause ectropion, the opposite condition in which the eyelid is rolled outward. I really like the pinch technique because it allows me to see how the the anatomy of the lid will change after removing the incorporated tissue. After removing the hemostats, the pinched skin stays standing up; this is trimmed away (called a blepharoplasty) and the resulting skin incision is sutured closed with very tiny, silk sutures. Most dogs need to wear an e-collar or satellite dish on their heads to prevent rubbing the surgery site as it heals. Stitches are usually removed in 10 - 14 days and once the hair grows back, you usually can't see much of a scar at all.

There isn't much problem with recurrence of the entropion except for in the very wrinkled, extra-skinned dogs like Shar Peis. Some surgeons may take a conservative approach to the initial surgery, only taking a small amount of skin during the blepharoplasty. They believe they can always go back to take more skin at a later date if the lid needs to roll out more, but it wouldn't be possible to put it back if too much was removed the first time. Some dogs require systemic or topical antibiotics and all should have pain relief medications for at least a few days post op.

Tucker's surgery went very well. I believe the repair resulted in a more comfortable eye for him, and I know his owners will be watching him for any signs of problems. He also got neutered that day, so he definitely got some pain relief medications and a nice big e-collar. When he recovers he can go back to looking as happy as he actually is-no more crying by Tucker!

Peace,
DrReneigh

A Horse is a Horse, Of Course, Of Course

2009-04-03T10:51:00.000-07:00

I've been preoccupied with some extra-curricular things lately so have been very neglectful of my blog. I just put a nice deposit on a beautiful saddle for my gorgeous horse, Raquel. Michael, my husband, had been making some noises like he wanted to start riding her, so I wanted to do all I could to encourage him. He wouldn't feel comfortable riding in my "funny" little English all-purpose saddle. I like that one because it is MUCH lighter, and lifting a heavy saddle way up on her back isn't fun. My old roper saddle I use when other people ride her is, well, old. I have tried to take care of it, but the leather is cracked (I have newer leather for the latigos and cinch so it is safe, just not very pretty....) and it kind of lists to one side on those longer rides, so you constantly need to shift your weight over to balance things out. It was just time to retire it.

I found quite a few Western saddles that would work just fine-but boy are they expensive! I'm generally not one for buying new things for myself at all, shopping for most of my clothes and all at stores like Value Village or Goodwill-thrift and second hand stores. Don't get me wrong, I usually find pretty nice, brand name clothes there. I just hate to pay full price for anything. I'm wearing my work dresses around jumping, slobbery, muddy, shedding dogs and cats, so I just don't want to spend tons of money on things that could easily get ripped or pooped or peed on. Well, I decided to splurge and get Raquel a nice new saddle this time-she's worth it, and so am I! But I wanted to be smart about it, especially with this crummy economy right now. So no credit for us. Lay-away would work just fine.

Even though she is a pretty big horse, Raquel isn't too difficult to fit for a saddle. But since I was planning to spend so much, (for me, that is-I know other people can spend many thousands of dollars on much fancier saddles!) I wanted to be certain of that fit. I arranged with a local tack store to take a few saddles home to try on her, being very careful not to get them muddy or hairy-quite the feat in this Spring season. She isn't anything BUT mud and shedding hair right now! I wrapped some plastic grocery bags over my feet and put saddle blankets on her and we took a few short rides around the neighborhood. Now I sure didn't want or need anything too fancy-we aren't going to be showing any time soon. No silver or lots of tooling (carved designs in the leather.) I was looking for something that fit her, fit me and Michael, was comfortable to sit in, and also looked nice.

I think I found a really nice one-I couldn't believe how comfortable it was! It has a gel seat and a flex-tree, so it should be just as comfortable for Raquel as it is for me. I'll be sure to get pictures when I actually get the saddle....you see, my thrift store nature came out after all. I took the manufacturer and model number and went searching on the web. I found the exact saddle, only it was a black one-perfect for my solid black horse!-for sale on Craigslist. The seller said she had only used it 3 times, so it was essentially new, and would save me over $800! How could I pass up such a deal? I felt bad about not buying it from the local tack store as I do like to spend my money locally, but I assured them I would be in frequently for all the miscellaneous things you always seem to need or just plain "have to have" when you are a horsey person. The saddle is in the mail as I type this, coming from New Hampshire!...I am very excited and this saddle is so nice that I might be converted to riding in the Western saddle more often! I just don't buy big things for myself very often, can you tell? I wonder if everyone gets this excited when they buy big toys? I hope so!

Speaking of Raquel, I have been trying to get her out riding more often lately. I joined a meet-up group of fellow horse lovers and we are actually going on a camping trip next month to the Oregon coast. It is a dream come true mixing two of my favorite things-horses and beaches! I sure hope we have some nice weather. It will probably be the first time my friend Kristen and I will be able to ride together-can you believe that? Neither of us has a trailer, so even though we live fairly close, we can't get our horses together-bummer. This camping trip will be a great thing since I hardly ever take time off work. I think everyone is saying "it is about time!" So, I am riding my big girl around the neighborhood a couple times a week and I just signed up for some riding lessons to work on better communication with her. I am really the only one who has ever ridden her regularly, starting her as a baby and all. It sure won't hurt to have that extra help to better both of our skills and to get us both into shape after a much too long winter.

I really like the folks in the meet-up group. It is the largest and most active equestrian meet-up in the world-right here in Snohomish/King counties! So far I haven't been able to ride with others, but we have frequent meet-ups where we have potlucks, sell our used tack and swap information. I'm the "animal health coordinator" so feel it is important to educate the group on all things veterinary-first aid, normal and abnormal vital signs, how to wrap leg bandages, etc. We are even putting together a binder of handouts on these topics for future use. I'm working with my staff at the hospital to put together an equine first aid kit, complete with bandaging materials, a stethoscope and thermometer and other things important for a horse owner to have on hand in case of an emergency.

So this blog will have at least a little bit of a veterinary topic today, here are the horse vital signs it is important to be familiar with. If your horse's numbers are significantly out of range, CALL YOUR VET!

Body Temp: 99.5 - 101.3 degrees F
Pulse rate: 28 - 45 beats per minute
Respiration rate: 10 - 14 breaths per minute

Take the temperature

Lubricate the thermometer with petroleum jelly, K-Y jelly or just spit on the end. It must be wet for good contact with the rectal mucosa.
Attach a string to the end of your thermometer. (They have been known to fall into bedding or even get "sucked" into the rectum.)
Tie a clothespin to the other end of the string so you can attach it to your horse’s tail while you’re taking his temperature.
Approach the horse from the side, and do not stand directly behind him.
Raise your horse’s tail and insert the thermometer into his rectum.
Wait at least 1 minute, then read the thermometer.
Digital thermometers are often very quick and accurate.

Find the Pulse

Use your fingers or a stethoscope to find your horse’s pulse under his chin or on the left side of his barrel, just behind his left elbow. It can also be located at the temple.
Each “lub-dub” is considered one beat.
Record the rate for 15 seconds and multiply by four to get your horse’s heart rate.

Check Breaths

Watch your horse’s chest move in and out, or cup your hand over his nostril and feel the air come out.
Use your stethoscope to listen to the breaths as the air travels across the trachea when he inhales and exhales. It should sound clear and consistent.
Note the characteristics of your horse’s breathing. Are the breaths shallow or deep? Are there any abnormal sounds like squeaking or roaring?

A horse’s daily water requirement varies from 5 to 20 gallons, depending on environmental temperature, workload, production state and feed intake. Providing clean, fresh water is a top priority for horse owners, especially if you are traveling.

The vital signs listed are for RESTING horses. If they are nervous or excited or just finished exercising, these will vary. Even just the sight of a thermometer or stethoscope can freak out some horses, so take this into consideration.

Happy trails, everyone!

Peace,

DrReneigh

Haley is Weak and Wobbly

2009-03-25T12:56:00.000-07:00

Wednesdays are usually pretty slow around here. We close early and don't usually schedule elective surgeries, sticking to well pet vaccine appointments, or seeing dogs with itchy ears, cats who got in fights-pretty routine stuff. But it never fails that a patient will come along with pretty vague symptoms but is obviously very sick-just like Haley did today. Haley is a 5 year old, very sweet and ordinarily energetic terrier that had been vomiting last week. She seemingly got better, but is now terribly weak in her hind end, can hardly walk, and is trembling all over. She seems cold, dehydrated and her owner may have seen blood in some vomit yesterday. Yuck. Remember our abbreviation lesson? Haley is ADR-ain't doin' right- for sure!

We started with a physical exam and taking her history. Haley wasn't usually the type of dog to eat things she shouldn't-no rocks or parts of toys or sticks and she hadn't gotten into the garbage as far as her owner knew. Besides, her "partner in crime," Henry, wasn't showing any signs of a problem. There were no medications or toxins out for her to get into, and no one had put out rat or slug bait or changed antifreeze lately. There was no diet change and she didn't get any new kind of treat. Her body temperature was indeed a little low, and instead of eliciting pain or just tension as I do on most dogs, her abdomen was completely flaccid. She was indeed limp in the hind end and her eyes seemed to be sunken into her head. She had a big glob of greenish material in her eyes and her gums were cold, dry and tacky. I thought she was dehydrated, but there had to be more to the story. I thought it would be a good idea to get a blood sample and run a profile to see what was going on in her body.

Getting a blood sample was easier said than done. Haley's veins were practically non-existent! At least her peripheral veins, the ones on her legs, were very difficult to find. We settled for drawing a sample from the larger jugular vein in her neck, and even that wasn't easy. Her cold body temperature and whatever was happening to her body seemed to be shunting her blood away from her periphery and likely to the more vital organs-her heart, brain and such. I sure was glad her owner got her in when she did!

We were able to run a panel on Haley's blood in-house in less than an hour while her owner waited. Her electrolytes were totally out of balance, with a dangerously elevated potassium level and very low sodium. Also significant was the very high phosphorus level and elevated creatinine kinase, the muscle enzyme. These blood results were helping me to understand better what was going on in Haley's body-and more importantly, what we needed to address to help her out. When electrolytes become as out of balance as hers were, it can be due to disorders of the endocrine system-and in this case I strongly suspected hypoadrenocorticism or Addison's Disease.

Addison's Disease occurs when the small adrenal gland stops producing enough of the steroid hormones we all need to help combat stress in our lives-gearing up for the fight or flight response when we face something scary or exciting. Corticosteroids come from the cortex or outer layer of the adrenal gland while mineralocorticoids come from the inner medulla area. The glucocorticoids (including cortisol, prednisone, dexamethasone and others) act on the mechanics of sugar, fat, and protein metabolism. They gear the metabolism towards the preparation of burning - rather than storing - fuels so as to be ready for a fight or flight situation.

The mineralocorticoids (such as aldosterone) influence the electrolytes called sodium and potassium. As a general biological rule, where there's sodium or salt, there's water. When the mineralocorticoids circulate as part of the fight or flight preparation, sodium is conserved in anticipation of blood loss so that there will be extra fluid in the vascular compartment (spare blood). When sodium is conserved, potassium is lost as part of the biological balance. This whole picture of fat mobilization, sodium conservation etc. that is part of the fight or flight preparation is far more complex than can be reviewed here but basically:

Corticosteroid hormones are needed to adapt to stressful situations and without these hormones, even small stresses could lead to physiologic disaster, as I fear is happening to Haley.

We often see these Addisonian dogs at fairly young ages, 4 - 5 years old. Females are more likely to have it, and Standard Poodles and Bearded Collies have breed predilections, but of course, any age, breed, sex dog can be affected. Cats can develop Addison's, but it is extremely rare. It is most likely to come to the diagnosis because of a "crisis" situation-a very sick or shocky dog as Haley is presenting. Older treatments for shock, fluids and steroids, just happened to be the remedy for Addisonian crises, too. Since it wasn't likely to hurt and could be very beneficial, we also gave Haley medications to reduce that dangerous level of potassium. We are also giving her medications to protect her stomach as her owner saw blood in her vomit yesterday. This should hold her steady until we get her resting cortisol level and determine if further testing is needed. We can then start her on a definitive treatment for Addisonian dogs-probably DOCP or Percorten, given once every 25 days or so. She will still need some supplemental corticosteroids, prednisone or dexamethasone, when she is undergoing stressful situations, and it will be essential to monitor her electrolytes carefully as fluctuations can cause the weakness and anorexia Haley showed today.

Haley is fortunate because she has an owner who really knew her normal behaviors and what to watch for-when she wasn't herself, she brought her in for an exam. Others have progressed to full blown seizures and worse before getting diagnosed and getting the help they needed. With all these things that can go wrong in our bodies, isn't it amazing how often they all work so well?

Peace,

DrReneigh

Run Quik, Run!

2009-03-24T10:39:00.000-07:00

Many people who know about dogs, especially the larger breeds, know that they can be prone to joint problems, particularly hip dysplasia. Just what is dysplasia and how does it affect our 4-legged friends? Dysplasia actually refers to the abnormal growth or development of the part of the body affected. My poor dog, Verbal, has both hip and elbow dysplasia. In hips, there would be a bad "fit" of the ball and socket joint-the femoral head and acetabulum. Normal hips have smooth rotation of the femoral head in the acetabulum due to this proper fit along with the cartilage covering and lubricating fluid in the joint.

When an animal (yes, there are some breeds of cats who also get this) has hip dysplasia, the ball and socket do not fit well. The acetabulum is flattened and the femoral head is not held tightly in place, causing slippage and subsequent friction. This makes for an unstable joint and the body’s attempts to stabilize the joint only end up causing changes in the bones of the joint-this is arthritis, and can occur even in very young dogs. Verbal was noticeably "rabbit hopping" in her hind legs due to discomfort when she was only 6 weeks old! That rabbit hopping gait when a dog is running or going up stairs can often lead us to a diagnosis of hip dysplasia, but not always.

We know that some pets may show their discomfort due to hip dysplasia at a very young age as Verbal did, or may not have pain until severe arthritis changes occur in the joint as they age. Radiographs of the joint show us the changes that occur, but the degree of those changes don't necessarily correlate with the severity of lameness. Some very badly lame dogs may only have minor changes on the x-rays and some dogs with terrible x-rays may never show pain. It is true that lighter weight dogs do better than overweight or even normal weight dogs, and some dogs are just more stoic than others.

Genetics are a major cause of hip dysplasia, so ethical breeders always screen their breeding animals BEFORE they use them in their breeding programs. The OFA or Orthopedic Foundation for Animals has a huge data base of many heritable diseases of animals, and hips are a big part of this. Preliminary testing can be done at any age, but "official" OFA radiographs are taken and submitted for evaluation at 2 years of age. These must be done under sedation or anesthesia to ensure accurate positioning (and in affected cases, pain free positioning.) That is why our handsome patient, Quik, came to see us this morning. He is still too young for the official testing, but his owner found out Quik has a half sister affected by hip dysplasia. It is just smart to do all she can find out early if Quik might be affected as well-before too much degenerative joint disease occurs as a result. Some treatments can be done on younger animals that wouldn't be effective on older ones.

Quik is a bit shy but his owner has worked with him a lot. He is a very good boy, and did well for his exam and sedation. We positioned him for his hip radiographs by laying him on the table and extending his hind legs back and flat, parallel to the table-definitely not a position an awake dog would want to make willingly! You'll notice the hips are symmetrical and the patellas are on top of the femurs-good landmarks to tell us we have decent positioning for the radiologist to evaluate the joint conformation. Quik isn't showing any signs of pain or discomfort and when I palpated the joint there was no problem with the motion in either hip. This is truly a screening procedure today. We also took radiographs of his elbows while we were at it and the radiologist should get us his opinion in a day or so.

I mentioned there are "treatments" available for hip dysplasia if we diagnose this condition. So far, Quik's hips look really good. In fact, his owner said he lifted his leg to pee just like the big boy he is for the first time this morning! Oh, the things we celebrate around here :) Young dogs with severe problems of conformation, such as when the ball is luxated or not in the hip socket can be treated surgically with a TPO or FHO-triple pelvic osteotomy and femoral head ostectomy. The TPO is a procedure where the pelvis itself is broken and re-plated in three places to re-position the socket over the femoral head. The FHO is considered a salvage procedure but I really like it and is what we did for Verbal. She actually didn't have a socket but more of a "plate"-that joint was really deformed-so re-positioning it wasn't an option. Instead, we removed the femoral head completely and therefore there was no longer any bone to bone contact-and no more pain. Her gait was fine after that, relying on the strong thigh muscles to support her limb-that is until she blew out her ACL in that same leg some years later! Very young dogs also may benefit from a juvenile pubic symphysiodesis, a procedure where the pubic symphysis (the cartilage seen connecting the right side of the pelvis to the left side) is fused early to allow for more normal alignment in puppies that may be predisposed to hip dysplasia.

Options for older dogs include total hip replacement surgery, where prosthetic joints are implanted, DAR arthroplasty where bone grafts actually build up the rim of the acetabulum to make a deeper socket for the femoral head to sit in. FHO's are still good options for older dog's, too.

Nutrition is a factor in "treating" as well as controlling degradation of the hip joint. Certainly we can't allow an affected dog to become too fat. Those large breed puppies who grow too fast or who have their bones and tendons grow at different rates put unnatural stresses on the bones, often causing dysplasia or other developmental problems to occur. One study showed that when puppies of hip dysplasia prone breeds were allowed to free feed, two thirds went on to develop hip dysplasia while only one third developed hip dysplasia when the same diet was fed in meals. Another study showed German Shepherds were nearly twice as likely to develop hip dysplasia if their adult weights were above average. Studies such as these have led to the development of puppy foods designed for large breed puppies, where the optimal nutritional plane is lower than for small breed puppies. It is just common sense that feeding a Great Dane is different than feeding a Chihuahua! There are nutritional supplements to help repair cartilage, pain medications, and anti-inflammatory medications. Physical therapy and massage are also important and helpful in non-surgical joint therapy. Many people have utilized acupuncture and other alternative therapies for their pets.

While I tease Verbal about being my "genetic disaster," it is actually true, and a heartbreaking thing to have happened to her. We can only hope that all people who breed dogs will be as responsible as Quik's owner is, screening for this devastating, painful disease and weeding out the affected ones from the gene pool. That way our dogs can run and play through out their lives, happy and pain-free-run Quik, run!

Peace,
DrReneigh

Happy Birthday to Me-Almost!

2009-03-19T10:44:00.000-07:00

I walked into the hospital this morning to be greeted by streamers and lime green (my favorite color) balloons, banners, even a pinata. My Birthday is in a few days, and my wonderful staff is spoiling me rotten today-aren't I lucky? They out do themselves every year-all the lions and giraffes and zebras are terrific-very festive and just right for the veterinary hospital. I love that they are all working together for me, as they always do.

Winston came in this morning and sure didn't seem too worried about all the decorations. He was wiggling and bouncing, much happier than his owner saw him acting yesterday when she was so concerned for him. He had been lethargic, not eating, feverish, vomiting-a pretty sick Rat Terrier. Those little guys are always busy, happy things-so this was very worrisome. We asked some questions of his owner and found out that right before he got sick, she fed him some raw chicken-very likely the culprit.

Even though Winston has been getting raw meat about once a week throughout his life, it only takes one time like this for an owner to really understand the potential dangers of feeding raw diets. Many breeders will hail the benefits, always coming back to "wild" animals and their raw diets being so beneficial to them-better hair coats, maintaining weight, better immunity-the list goes on and on. If there is an ailment, raw diets have been reported to be the cure-all. But we know that like any food, balance is the key. Raw diets may have their place, but often are fed by people who don't understand the concept or don't take the proper precautions-and the pets pay the price.

The fact is, dogs aren't closely related to wild animals at all. They have been domesticated for some 50,000 years! Their digestive systems have evolved beyond that of a coyote or wolf, so comparing them really isn't accurate. While it is possible to feed raw diets in a healthy manner, it is expensive and very time consuming to do so. Consulting with a veterinary nutritionist is essential to determine your individual pet's requirements-it isn't enough to throw some meat and veggies and rice in a blender and call it good.

There are some very real risks to feeding raw diets-and I have seen and treated all of these, including Winston's likely case of gastritis/enteritis. Perforation of any part of the GI system from the bones fed in raw diets is immediately dangerous. I have also seen impactions of bone material when it has been properly chewed up but accumulates in a tubular organ. Broken teeth from the very hard bones is also a risk, no matter how beneficial they may be at cleaning the teeth. These problems may be minimized if the bone is ground up in a blender before feeding.

Nutritional inadequacy is very common, as I mentioned. Osteodystrophy and rickets can occur when diets aren't balanced. There is at least one raw diet that has undergone AAFCO feeding trials, Nature's Variety Instinct, so this can just be purchased and fed as a complete raw diet. If people are set on preparing their own food, consulting with nutritionists at veterinary teaching hospitals or through websites like: www.monicasegal.com and www.balanceIt.com who offer information about raw and home made diets.

The other main concern about raw diets is the contamination with pathogens. This shouldn't be a huge problem in otherwise healthy dogs or cats, but can be an issue in very young, very old or immunosuppressed animals-and people. Don't forget the risk to the humans preparing the food. A relatively unscientific survey by Consumer Reports of grocery chicken showed 80% contamination with Campylobacter, and about 15% with Salmonella - organic and free range were worse in this survey. E. coli is ever-present as well. We have many researched journal articles that support this concern too. So, just the public health issue is enough to make this way of feeding undesirable-simply cooking the ingredients eliminates the pathogens.

You would think that the treatment for exposure to bacteria would be antibiotics, but not in Winston's case. He was actually suffering from a condition caused from the death of those bacteria and the subsequent release of the toxins they produce upon dying. This is called endotoxemia or endotoxic shock in severe cases. Killing off more bacteria could result in worsening of the condition. We instead treat with lots of fluids and some medicine that is anti-endotoxin if needed. Since he really was improving over just last night, we decided to treat him as an out patient and have his owner monitor him at home. We loaded him up with some subcutaneous fluids (SQ fluids)-allowing them to absorb through the small blood vessels called capillaries in the fatty tissues under the skin. His owner will likely forgo the raw meats in the future and instead will likely cook any extra meats she offers him-just to be safe.

It is true that many toxicities have occured from traditional commercial diets due to contamination and dangerous additives-so they aren't guaranteed for safety. Still, they are less risky over all and generally the better choice for busy people who just want the best for their pets.

More surprises awaited me at lunch time-my crazy, wonderful staff decorated the treatment area with more jungle attire and laid out a huge meal for all to share. They gave me a sweet jungle animal card with some VERY generous gift certificates-I have told them over and over to not spend their hard earned money on me, but they have huge hearts-as you would know if you have ever had them care for you or your pet. One of the certificates was perfect for the day's theme-admission to the zoo! We even had jungle themed games-pin the tail on the lion, limbo and others-all with great prizes, too. Verbal, my goofy yellow dog, was right in the middle of all the food and fun-we had to stop her quickly when the pinata was broken-all that candy all over the floor was very tempting. I bet Twitchi and Noodles, our hospital cats, will be finding wrapped candies for quite awhile!

So, I get to celebrate my birthday for several days in a row instead of just a single one like "normal" people do. I guess I wouldn't like that if I was really bothered about my age, but what's a few more gray hairs compared to all this fun and support from good friends and co-workers? Happy Birthday to me-almost!

Peace,
DrReneigh

Yes, Roscoe, Miracles Do Happen

2009-03-17T14:08:00.000-07:00

An appointment about a month ago looked simple enough on the calendar-check cough. I was presented with Roscoe, a bouncy, happy 2 1/2 year old Boxer, full of life and very much loved by his human family. And yes, he was coughing-a harsh, dry cough, almost a honking sound that came from deep within his chest. He looked exhausted-as did his humans. No one could sleep with all that coughing going on. Now, "kennel cough" certainly can present this way, as can a myriad of other conditions and diseases. Simple rest and cough suppressants usually do the trick. But Roscoe was a sick dog-he was losing weight and this cough had been going on for some time and it was only worsening. I thought it would be best to take some radiographs of his chest to be sure we weren't dealing with one of the more serious conditions right off-and his owners agreed.

No one expected what we found. He was only 2 1/2 years old after all! Roscoe had masses throughout his lung fields-and one giant one on the right side of his chest. Because of his breed (Boxers, unfortunately, have a very high incidence) and the sudden onset-and now this terrible finding in his lungs, lung cancer had to be high on our list of differentials, or rule-outs, as the cause of Roscoe's cough. Understandably, his owners were just devastated when they saw the films and the news sunk in. Remember how I wrote about "It Is A Whole Family's Diagnosis?" This was certainly the case for Roscoe. He had some young children in the family, too, who just wouldn't understand this horrible news. We set about making a plan for confirming what we suspected and getting him any help we could.

First, we decided to do some blood work-it looked really good. That could mean there was a lower chance that this aggressive looking disease had metastasized or spread to other organs of his body-although blood work is not definitive in this regard. Next, we attempted to take a fine needle aspirate or sample of the cells of that large mass in the right lung field. We took several samples-and got several different cell types back! It was frustrating. The pathologist couldn't commit to a single disease, saying that the different cells were indicative of several conditions. Finally, we decided to send Roscoe to the veterinary oncology specialists and have them evaluate him.

The oncologists were quite pessimistic as well. They took some follow up chest x-rays and the mass in his chest had actually doubled from the time when I had seen him-in just a week! They suspected primary lung cancer and as ill as he was during his visit to them, didn't expect him to live longer than 1 to 2 weeks. Roscoe's owners were distraught. They asked if there was any chance this could be something else-he was such a young dog! The oncologists explained that Boxers were a "special" breed when it came to cancer, and we can actually see it in any breed, but in a 2 1/2 year old Boxer it wasn't as surprising. Tragic, yes. But they did say that there was another disease that, although very rare, could manifest in a similar way as Roscoe's disease had. This condition is called pulmonary infiltrates with eosinophilia-or PIE for short.

I had never heard of this kind of PIE, so did what research I could. There wasn't much out there, but we did find that if Roscoe had this condition, he would respond very quickly and very dramatically to a simple drug called prednisone. No need for the more advanced (and costly) chemotherapeutic medications, just this antiinflammatory drug. We had absolutely nothing to lose, so Roscoe was started on the pred. Well, you guessed it-he got better! His owners were hesitant to get their hopes up after such a dismal prognosis from both me, their primary care giver, and from the specialists. We called them a few times over the week and each time they reported decreased coughing, better energy, more sleeping through the night-everything he needed to be doing.

Just to be sure, we had Roscoe in this week for some follow up radiographs of his chest. We figured they couldn't "lie" to us. We could see if those masses were decreasing in size or if it was just false hope as his owners feared. Look at that picture! The big mass is almost gone! I couldn't find all those little ones at all. It really was a miracle! I rushed to show the films to Roscoe's owner in the exam room-she was so excited she had tears of joy and gave me a big hug. Oh, it felt so good, especially after the terrible time that family went through.

Roscoe was one of the fortunate ones, for sure. He'll have to be on the medication for quite a while, but that's OK. He seems to be handling it fine-the alternative is unthinkable. We can't expect things like this to happen all the time-that's what makes miracles, well, miraculous! I am very thankful for this one case turning out as it has, and will do my best to pursue all options for my patients, even when the eveidence seems seems overwhelmingly bad. Miracles do happen.

Peace,
DrReneigh

It's A Whole Family's Diagnosis

2009-03-13T11:50:00.000-07:00

I was talking (or rather e-mailing) to a friend the other day about the stresses each of us face day to day in our respective jobs. We are fortunate, of course, because we actually do have jobs, and actually like what we do. Not everyone can say that, for sure.

We were having this "discussion" on the day after Tasha, a beautiful, sweet Golden Retriever had been in to see me. She had some ominous swellings under her throat, in front of her shoulders, in her axilla (arm pits) and inguinal region (groin.) These are all areas you will find a dog's lymph nodes, and even though enlargement can occur because of infections, I felt this wasn't the case for Tasha. We took aspirates of those swellings, put the material on slides and submitted them to the lab for a diagnosis. Sometimes needle aspirates are non-diagnostic or only suggestive of certain conditions or diseases. This wasn't the case for Tasha-the diagnosis was definitive-she had lymphoma.

Lymphoma is a cancer of the lymphatic system, the nodes and vessels in our bodies through which foreign material or organisms get "filtered" or dealt with by the cells of the immune system. There are actually a number of different ways this can occur. Some cells produce antibodies, others phagocytose or literally "eat" the foreign material or organisms. Some "turn on" other cells, regulating their activity to help destroy those invaders.

Lymphocytes are the main cells of the lymphatic system and they act in all of those ways mentioned. The lymph vessels serve as a circulatory path for lymphocytes as well as being a collection system directing foreign substances toward the lymph nodes where the processes occur. Lymph vessels connect with the blood stream at several points allowing lymphocytes access to virtually the entire body.

Many people who "always wanted to be a veterinarian" mention their love of animals, their goodness, how wonderful it must be to work with them, etc. But most forget the very real "human factor" of veterinary medicine. Who is actually bringing that pet in to the veterinarian to begin with? Who is responsible for describing the illness or symptoms-certainly a good physical exam reveals a lot, but really knowing a pet's personality and how his or her behavior is changed is essential to coming to a complete diagnosis. And of course, who will be administering any needed medications? Loving animals isn't enough to work in the veterinary field, really in any capacity. Humans are a pretty important component.

The human-animal bond is a wonderful thing-we see examples of it every day. An older man with his cat-talking with him I found out she was actually his recently deceased wife's cat, and this kitty is his link to her. A bouncy, happy Cocker Spaniel puppy-in a household full of kids because of a daycare situation. A Border Collie who's job it is to alert her owners to oncoming seizures so she can get herself into a safe place/position. You remember Mikey and his owner-she is working very hard to afford his treatment for cancer. The list goes on and on...and on! It is awesome to see the varied ways the bond is manifested-we love humans who love animals!

So it goes that when I make a terrible diagnosis like lymphoma, it really isn't just Tasha that gets that diagnosis. It is the entire family's diagnosis. Of course they all were devestated. I found a couple of booklets that I hope will help Tasha's children in the family hear the news of her cancer and how to cope with her impending death. The books might allow them to put together mementos, photos, poems or other writings about her. I gave her adult humans information on lymphoma itself, how it could be treated, referral options to veterinary oncologists, chemotherapy, the works. The whole family will have to be involved in the decisions that will have to be made, what kind of treatments to select, how much money can they afford to spend, when is it time to say "enough" and just how will we go about saying that final goodbye? Will each person want to be with her at the end or prefer to say goodbye and remember her that way? Should we arrange a home visit for the euthanasia when the time comes, or will that leave unpleasant memories associated with the home? Everyone is different in how they feel about those things. We gave Tasha's family a brochure about "how to know when it is time"-a question everyone struggles with. This is so very hard!

I am lucky to have this blog to write about the emotions that sure do seem to be overwhelming at times. And friends and family as I mentioned who "get it." They know I'm not the kind of person who can work 9 - 5 and turn off my emotions when I step out of the hospital. I'll be thinking about, researching for, worrying about and praying for those pets and families who love them long after the designated appointment time. But I try not to dwell on my cases-I have a lot of "extra-curricular" activities, and my own critters certainly help! My entire family comes together for me-just like Tasha's will for her.

Peace,

DrReneigh

Take A Deep Breath

2009-03-12T09:46:00.000-07:00

Well, the radiologist's consultation of Stella's chest x-ray's came back yesterday-diffuse bronchial thickening consistent with feline asthma. Other less likely rule-outs are bacterial bronchitis and aelurostrongylosis (lung worms.) Whew. No mention of cancer. Since her blood work didn't really show evidence of infection, and because she is an indoor cat with very little risk of exposure for lung worms, I am going to start treating her for asthma first and see how she does. It only figures that this cat, who disappears under the bed, far, far from reach the second you just think about medicating her, will be the one who needs life long maintenance medications. Oh joy. I certainly feel the pain of all my clients who swear up and down they just can't medicate their pets-Stella does not make it easy. I can only imagine the U-Tube video of me crawling under the bed, (always when I'm late for work!) grabbing her tail and dragging her out hissing and spitting at me. Thank goodness the actual pilling act isn't hard-I've had plenty of practice medicating cats!

Thank you, everyone, who expressed your concern for Stella and for me. I appreciated the kind comments, Nicki, and the moral support-you do understand what it is like to be "mom" and doctor at the same time.

So, just what does this diagnosis of feline asthma mean for Stella...and for me? The problems start because of changes in her lungs. The airways actually constrict because of the formation of mucus, the inflammation of the airway and subsequent ulceration, and finally actual spasms of the airway muscles. When the airways are constricted, the cat can not take a deep breath, won't be able to exercise or play for long periods, will have coughing episodes, (as Stella does)and they may wheeze when they breathe. So far we have been lucky in that Stella has just had the low-grade, chronic cough as her only symptom, but an acute or sudden asthmatic crisis can occur at any time and could actually be life threatening as I have seen in other patients. There may be no obvious reason for the crisis, or it may be triggered by allergies or stressful events.

It is likely that the airways of affected cats are diseased all the time and actually flare up and worsen during the crisis episodes. This is very similar to what occurs with human asthmatics. That is why treatment is likely needed all the time, not just during those respiratory emergencies. Our goal, of course, is to try and prevent those emergencies. So, darn it, Stella will need long term medication. Looks like I'll be crawling under the bed with her quite frequently.

Since the primary cause of the airway constriction in asthmatic cats is inflammation, it makes sense that treatment revolves around anti-inflammatory medications. Corticosteroids are the gold standard for reducing inflammation and can be administered orally, by injection and even by inhaler. Don't laugh! Cats can and do receive inhalant medications for asthma just like humans do, although specially fitted masks need to be used. Other medications that can be helpful are airway dilators such as terbutaline. Because allergies often trigger severe asthma symptoms, antihistamines can be helpful for many asthmatic cats. Cyclosporine is an immunomodulator that is relatively new in its use for asthma cats. It is particularly useful for those cats who can not tolerate corticosteroids because of their side effects, concurrent diabetic cats, cats with calcium oxalate bladder stone histories, etc. It can be expensive, but cats are small so dosing shouldn't be prohibitive.

Environmental control is imprtant in these asthmatic cats. Remember we talked about second hand smoke causing respiratory problems in pets? Never smoke around an asthmatic cat. Try to use dust-free cat litter, and regularly replace air filters in your home. I have seen some cats who develop sensitivities to laundry detergents or fabric softeners, perfumes, even carpet cleaners, so evaluate your home for sources of possible irritants to your cats respiratory tract. Remember, they are much closer to the ground and very, very sensitive to environmental changes.

If Stella becomes too wiley or difficult to medicate every day, I may have to resort to an injection of a long-lasting corticosteroid to control the inflammation in her airways. It isn't without its risks, however, but could be a good alternative to fighting with her every darned time she needs a pill. Stress can trigger those crisis episodes-definitely something we want to avoid!

So, feline asthma is a crummy diagnosis because it is a disease that is rarely "cured." We can only hope to manage it and avoid the terrible respiratory emergencies, gasping for breath, tongue turning blue episodes that can be life threatening. Leave it to a vet's cat to come down with it-thanks a lot, Stella. Actually, I am quite relieved her cough wasn't anything more serious, and am hoping her new medication will help her take that deep breath and stop her coughing real soon. She has to be fit to be able to run away from Spartacus when he attacks her, after all.

Peace,
DrReneigh

STELLLLAAAAAA!!!!!!!!

2009-03-10T16:13:00.000-07:00

The title of my blog seemed relevant again today. No, Spartacus hasn't relapsed or anything. Today it is his sister, Stella, that reluctantly came to work with me today. Very reluctantly, actually. I had to crawl under the bed and grab hold of her tail (dang, don't tell her vet!) so she wouldn't run away again, finally stuffed her into the carrier and got her into the hospital. Maybe she associates the carrier and the car with going to cat shows when she was younger. Stella was, and still is, a gorgeous Maine Coon cat, and it was with extreme pride that I took her to several cat shows to show her off. She HATED it. I had only shown two other cats before her, and for only a very short time, so I saw the huge difference between cats who genuinely loved the attention, all the primping, combing, fluffing up (I doubt any cat really likes the bath part..) and Stella. They would come to the front of their cages, reaching out to passers by, meowing and purring, arching their back for the petting by the judge, playing with offered toys, really strutting their stuff. Stella hunched in the back of the display cage, crouched into a ball when the judge picked her up, and trembled with fear when it was all over. Needless to say, her show career didn't last long.

Stella has been coughing for a while now, but recently she has been doing it every day. It is one of those harsh, hacking coughs, non-productive, where she extends her whole neck out and down as if she is going to pass a hairball-but she only rarely does that. I have been combing her a lot to try and decrease the amount of hair she might ingest, but that didn't reduce the coughing episodes. I have found that I don't tend to do a very thorough job when I "examine" my pets at home, so off to the hospital she went today.

Her nurses weighed her and took her temperature-all was fine there. She isn't fat like her brother, Spartacus. I listened to her heart and lungs-other than having an elevated heart rate, likely due to fear, her chest sounded fine. Her oral exam was great-Stella has been a fortunate pedigreed cat in that her teeth and gums have always been healthy with minimal care on my part. Many of my other "pure-bred" cats haven't been as lucky, often having severe orodontal disease. I could elicit or cause a mild cough when I palpated Stella's neck, but it wasn't anything like the harsh, extended neck episodes she does at home. I wasn't convinced the issue was with her neck or throat. Her abdomen palpated fine, and the rest of her exam was normal as well.

Since Stella wasn't readily letting on the cause of her cough, I decided to pursue some further diagnostic tests while I had her here. Her nurses drew some blood for a general panel and CBC (complete blood count.) They also took chest radiographs, but since she is small, most of her body fit on the x-ray plates. We got good views of her abdomen, too. Her blood work showed one value a bit elevated-the CK or creatine kinase, a muscle enzyme. It can be elevated for many reasons, often from trauma to muscles as happens after being hit by a car or after a grand mal seizure, or the CK can be high when there is heart disease. The heart is muscle, after all. I've also seen it elevate after soft tissue trauma, such as after surgery. The value can change rapidly, so a single elevated value should be taken with a grain of salt. I will likely repeat it periodically to see if it is a trend (for it to be rising) or if it is actually on the way back down. But I did have two relatives of Stella (half brothers) die from heart failure at very young ages, so you can bet I will be watching this value. Coughing can certainly be a symptom of heart disease.

Her chest radiographs were more concerning. It looked like there were some fuzzy patches or splotches in her lung fields-possible masses? These could be anything from bacterial or fungal infection, (pretty rare in this area) parasites, (lung worms?) changes from asthma, or (gulp!) even cancer. Stella would be awfully young for this, (she is 5 1/2 years old) but we have seen that cancer can do any darned thing it wants to, so we have to put it on the list of rule-outs. I decided not to panic (yet!) and sent the films to the radiologist for interpretation. It will only be another day or two to find out what he thinks and then I can make a plan to treat her. I sure don't want to jump to any conclusions, but you can imagine my mind is going in a hundred different directions thinking of worst case scenarios.

Stella will be more than happy to hop into that carrier now. She certainly knows it means she is getting the heck out of here, back to her buddy, Spartacus, waiting at home for her. I feel bad I waited so long to bring her in and deal with this cough, but just like any other pet owner, I knew how much she hated "going to the vet," what a pain she was going to be to medicate if that's what we decide to do for her, and I was honestly hoping it would just get better on its own. Where have I heard that before? I'll be sure to keep you posted on what the final diagnosis is, if we do indeed come up with one, and how she does with everything. Sometimes it really sucks being a vet's cat!

Peace,
DrReneigh

How Do You Know It Is Time?

2009-03-09T16:08:00.000-07:00

It was a snowy day here (Come on! It is March. We should be done with that nonsense already!) so there are quite a few empty spots in the appointment book. I'm certain that is why the appointment for a euthanasia of an old dog made such an impact. They generally do, actually, and that is as it should be. The day that my staff and I can put an animal to "sleep" with no emotion is the day we should consider leaving the profession. Each and every euthanasia appointment represents the end of a relationship between that human or family and their special friend. Perhaps that pet is the last link to a deceased spouse or parent. Maybe they are the only source of friendship or comfort and support to a lonely, single person or one who has a serious illness. Bonds between children and pets are so wonderful-and don't last long enough. Service dogs, of course, have very important rolls in the lives of disabled people. The types of relationships are as varied as are the reasons for making that final appointment.

It may be simply "old age." Old bones and joints lose their bounce and freedom of movement so even the most simple actions are painful. Organs like the liver and kidney and heart can fail, and even though we have come a long way in the treatment of many of these diseases, there does eventually come a time when treatments are no longer helping the patient and may even be a source of stress. Medicating an old cat who fights violently every time just may not be the "right" thing to do to the cat, much less the relationship between that cat and his human. I had a wonderful old tabby cat named Tony who had a form of glaucoma when he got older. He was prescribed some eye drops by our ophthalmologist. Tony HATED them! He acted like I was putting acid in his eyes every darned time I did them. I just couldn't see putting him through that even if it could have helped his eyes. That darned cat!

Sometimes emergencies come up, pets can be hit by cars, mauled by other animals, endure broken bones eat things they shouldn't-the list goes on and on. Some of these situations may not be fixable; others may treatable be given extreme amounts of money that an owner just may not have. We talked before about euthanasia for aggressive animals-ones who can't safely be adopted out. Regardless of the situation, your decision to have your pet euthanized is very serious, and never easy to make.

You aren't alone, though. Although ultimately you alone are responsible for your pet's care and welfare, your friends and family may have valuable input into your situation with your pet. But you should never make the decision simply because a friend or family member tells you to. You should also consult with your veterinarian before the time comes. They can help you decide not only what is right for the pet, but can ask some questions to help you decide what is right for you, too. Be sure to ask questions about your pet's medical problems that might be a factor-don't be embarrassed to have them repeat the information or ask them to write things down. I have often had clients who will be facing the decision soon come in ahead of time to sign all the paperwork and even pay for it if they wish. That way you don't have to deal with all that stuff when those inevitable strong emotions are at hand. Some people wish to arrange for home euthanasias if their veterinarians offer this service. I also have some little booklets and handouts that can help children (and you) prepare to say goodbye-it is really best to be straight forward and honest with them.

You will very likely know when it is time. Really. You spend so much time with your special friend. You know what they like doing, eating, who they love to be around, get up to greet-everything that makes their life worth living. If a pet is no longer enjoying say 3 out of the 4 most important activities in his or her life, the time is likely near. Are there more bad days than good? Does he or she have a terminal illness and the emotional and financial strain is just too much to handle any longer? Would you, in all honesty, be willing to trade bodies with your pet and live their lives?

Once you've come to this difficult decision, you have still another decision to make-aftercare of your pet's body. Some people are fortunate to have property where it would be appropriate to bury a beloved dog under his favorite shade tree in the back yard. Cremation is a popular choice, with your pet's ashes either being returned or distributed in a group and used as fertilizer-life goes on. All my deceased pets were cremated (except my horse Ladyhawke) and their little urns are on my fireplace. I envision them all going in with me when my time comes!

The actual euthanasia is usually very quick and quite painless. We often shave over a vein on the leg of a pet so we will have better access to a vein, but sometimes they are difficult to find in older, debilitated pets. Some veterinarians give sedatives prior to the injection of a massive overdose of anesthetic agents. These are often brightly colored fluids so they can't be mistaken for anything else in a hospital setting. Following the injection, the animal will likely stop breathing and their heart will stop. The veterinarian or assistant will listen to the heart to be sure this has occurred and let you know your friend has passed. There can be sporadic twitches or contractions, even actions that sound like gasping for breath, but these are unconscious -the pet is not trying to come back. Many pets will void their bowels or bladder. Their eyes usually remain open, the natural position.

Not all people feel they should or could be present at this point. It is a very personal decision and we respect each owner for making the choice that is right for them. Some may want to be present until the pet is sedated only and then leave. Regardless, the procedure will still be carried out in as compassionate and as dignified manner as possible.

I wrote about grieving and bereavement in a previous blog. Grief over the loss of your friend is very real, one you should not feel embarrassed to share with your veterinarian-he or she will understand, even when other friends or family members might not "get" what you are going through. It will be very hard, and you will no doubt be very lonely after such a loss-I am always so sorry for that. But I can rest easy knowing I provided the best I could for the pet-you should, too. It is the ultimate gift of love.

Peace,
DrReneigh

Kill Those Cancer Cells!

2009-03-05T13:22:00.000-08:00

Do you remember a special dog I wrote about named Mikey? He had a big spleen we had to remove because it was big and bleeding. Unfortunately, it was found to be enlarged due to hemangiosarcoma, a type of cancer of vascular organs. It had spread to at least one lobe of the liver, too, so just removing the spleen wasn't going to help him for long. Mikey is fortunate to be owned by a very loving human who wants to do the very best for him. After consulting with veterinary oncologists, we decided to start Mikey on a course of chemotherapy after he healed from surgery.

Now the principle behind chemotherapy is simple: kill those wandering cancer cells that were left behind after surgery. But the drugs used to do this can be very toxic to the organs of the body and their otherwise healthy cells. So there can be a fine line between effective doses (killing the cancer cells) and toxic ones (those that could make the patient ill.) We certainly don't want the treatment to be worse than the original disease.

We probably all know humans who have undergone chemotherapy themselves. It can be very nauseating, patients often lose a lot of weight, can have their hair fall out, or experience other side effects from the drugs. It can be difficult to know if these are really side effects from the drug or a progression of the cancer disease itself. Dogs are usually pretty tolerant of most chemo drugs. Even still, we take precautions like administering anti-nausea medications prior to giving the chemo agents. Mikey is a pretty sensitive dog-he goes through episodes of being picky about his food, anyway, and this second dose of chemo is really making him nauseous. Despite the anti-nausea medication, he has vomited and he just isn't eating yet, and it is going on day 4. I am going to check him over this afternoon and see if there is anything else going on.

Dogs rarely lose their hair due to chemotherapy. I used to say"never" but many years ago I had a very sweet, beautiful Standard Poodle patient with a soft tissue sarcoma that actually did lose all her hair after the very first dose of her chemo drug! It was quite a shock. I called the veterinary oncologist and they assured me that poodles were the exception and yes, it would grow back in just like human chemo patients. There weren't any wig makers for poodles that I knew of, though.

Nutrition can be an important part of fighting cancer. Mikey is on a prescription diet called N/D for "neoplasia diet." It is formulated to keep his cancer-stressed body healthy while starving those constantly dividing cancer cells. Some people choose to formulate their own homemade diets for this purpose, but we are so lucky that we have the prescription diet folks do it for us now!

Most chemotherapy is administered in rounds or specific protocols depending on a few things. Staging a cancer can really help decide which protocol will give the optimum results, and even this means different things to different people. For some owners, it is the longer survival time. For others, it is the best quality of life-good palliative care, pain control. Aspirating or taking samples from regional lymph nodes can help determine if the cancer has spread in the body. Radiographs or ultrasound can search for evidence of this metastatic disease. We only had to look around when we had Mikey's abdomen opened up to visually identify the affected liver. We did take chest radiographs, though and at the time, they appeared free from tumors. We chose a chemotherapy protocol where his drug is administered intravenously during a day in the hospital once every 21 days for 5 times. He wouldn't have to stay over in the hospital unless there were any complications from the drug or from the cancer itself, and so far, other than his nausea, he is doing remarkably well.

Prior to most chemotherapy regimens, we draw blood to test the complete blood count of the patient. We want to be sure the medications and/or the cancer isn't suppressing the immune system or affecting the patient's ability to handle the next round of therapy. Because of this testing, the hospital stay, the cost of the drugs themselves, the pre-medications, the special diet and supplements, treating cancer can be extremely expensive for a pet owner. Of course, there are no guarantees of success when we are dealing with such a serious condition as cancer. Mikey's owner knows all this. She is far from wealthy, but her love knows no bounds. She is hard at work, raising money to help continue his care. We have searched to find the least expensive source of his medications, and treatments every 21 days rather than weekly sure does help. He is one lucky dog! We all should be loved that much.

Peace,
DrReneigh

If you smoke, quit for your pet!

2009-03-04T12:06:00.000-08:00

By now everyone knows how dangerous smoking is for you. Even the dangers of second hand smoke to family members, especially children, co-workers, fellow diners, etc., are well known and have resulted in so many laws on the books as to have made smoking in public places virtually impossible. Thank God for that. But there are still far too many people who do not realize the dangers of second hand smoke to their furry and feathered family members-it can and does hurt these animals, often more so than their larger human counterparts.

It isn't just the awful smell in the fur that I notice when a smoker's pet comes in for an exam. They will often have red, irritated eyes, a dingy, dull hair coat, and very often have a cough or other respiratory problems, many times the very reason for the visit in the first place. Dogs who live with smokers are more likely to get nasal and lung cancers than those who live with nonsmokers. Brachycephalic (the flat-faced ones) dogs are at higher risks for breathing issues and lung cancer while longer nosed dogs like greyhounds are predisposed to nasal cancers. Smoker's dogs also scratch and chew at their skin just like allergy dogs do. Indoor cats living with smokers have twice the risk of lymphoma, a deadly cancer, and a higher risk of oral neoplasms. This is probably because the carcinogens settle in their fur and these fastidious groomers lick them off constantly, getting these cancer-causing chemicals in their mouths. We see a much higher incidence of asthmatic and lung inflammation problems in smoker's cats. Birds and small mammals like hamsters and rats are even more vulnerable due to their smaller sizes and higher metabolic rates. They are often sneezing, coughing, have eye problems and feather plucking when sharing the home of smoking humans.

When a critter comes in for a health exam and I notice the tell-tale smell on their fur, I try not to be accusatory or judgemental. I have had my own share of issues and know the smoker likely wants to quit themselves. But I do gently warn them about these dangers of second hand smoke to their pets, and some people are genuinely surprised about it. I do remember one older lady who had smoked for years. When she learned her habit was likely the reason for her little Yorkie's terrible cough, she first strted smoking only outdoors. She was finally able to stop altogether. I was so proud of her! She hadn't been able to do it for herself, but did make the huge change because of her beloved friend.

If you do smoke, be sure to do so away from the area where your animals live. It isn't enough to simply open a window. Smoke outside only, and be sure to tell visitors not to smoke in your home. Never smoke in your car with your dog, even with the windows rolled down. After smoking, be sure to wash your hands before petting or holding your pet. Nicotine can get on your hands and be transferred to your pet's fur. And definitely be sure to keep packs of cigarettes or butts, ashtrays, cigars, nicotine gum or patches or even smokeless tobacco products well away from your dog or puppy. Nicotine in these products is very toxic and could even kill a pet if enough is ingested. Call your veterinarian or poison control if you suspect this has happened.

Smokers know they need to quit, but it sure can be hard. Here is a website for more info about second hand smoke and how to quit:
www.cdc.gov/tobacco
Do it not only for yourself but for the health of your beloved pet. They will breathe easier and thank you for it. And you will certainly live longer-the more time to spend with your pets!

Peace,
DrReneigh

Advocacy for CJ

2009-03-03T16:38:00.000-08:00

Being a veterinarian has it's challenges in regards to asking a patient "where does it hurt?" Our critters usually can't speak up when they are injured, ate something bad, or just plain don't feel well. Now, my dog's name is "Verbal"-she certainly does her fair share of talking to anyone who will listen, but when it comes to making a diagnosis of an illness or injury, I as her owner, have to speak up for her.

Being an advocate for your pet's health is so important, an essential condition of ownership in my book. A recent case really illustrates just how it can make a difference; sitting back passively waiting for doctors to help just didn't cut it for CJ.

CJ is a personable, 7 1/2 year old Border Collie who moved to Washington state from Arizona (an important part of his history we will come back to) a couple of years ago with his humans. They noticed him having some hind limb lameness, occasional stiffness attributed to hip dysplasia or arthritis pain. But last summer he had a very arched back and we found he was knuckling his hind feet. He had decreased proprioceptive and righting reflexes-he didn't "know" where his hind legs were in space. That is usually automatic for us, something we do without thinking about it. When CJ's hind feet were turned over, he took some time to right them again. This is usually due to a lesion in the spinal column slowing down or interfering with the transmission of information from the leg to the brain and back again. We decided to take some radiographs of CJ's spine, but also hoped to include some of his abdomen in the pictures as he had some symptoms of abdominal discomfort, too. He was not only painful but also nauseated, not eating as well, which can certainly happen because of pain. CJ's x-rays really didn't help much. They did not show any bony problems with the spinal column or abdominal organ abnormalities. It did tell us that neither his hips or other sources of arthritis were a cause of his discomfort-there was no evidence of these problems anywhere on the radiographs. A bland diet and pain medications along with gastric protectants only helped him sporadically.

CJ was back in to see me when his symptoms seemed to worsen. His back became more arched, he was very cautious about lowering himself to the ground before eating (he wouldn't just lower his head to eat from a standing position) and he seemed to have trouble negotiating himself out of the corner he got himself into. We ran some blood work to see if he could have picked up an infection as a cause for the signs. The blood work didn't help in that regard-it was perfectly normal. We began to discuss the possibility of referring CJ to a specialist, likely a neurologist, for a spinal tap and perhaps advanced imaging such as an MRI for further diagnostics. Another option was to try CJ on a course of antiinflammatory medications-and this is the direction we decided to go.

The response was pretty immediate. CJ felt better, was back to playing with his buddy, Storm, and if we kept him on the gastric protectant, he even ate better. In the meantime, CJ's owner arranged for a consultation with the local veterinary neurologist. We sent copies of our lab work and x-rays with CJ, and after examining him, this doctor confirmed our suspicions of a spinal lesion in CJ. He recommended the spinal tap and MRI, both expensive tests that require general anesthesia, and likely leading into surgery if indicated by their findings. Not long after this, CJ developed severe, bloody diarrhea, likely a side effect of his medication. We tapered him off his medications and added others to combat the side effects. His diarrhea symptoms resolved eventually, but then his back problems came back in full force. His owners saved up the money and got him in for the recommended MRI and surgery.

CJ had a spinal mass in his lumbar region-the prognosis wasn't good. The neurologist was quite worried this was a tumor, but hadn't seen one that involved 2 disc spaces as this one did. They were not able to de-bulk it well as it infiltrated the delicate tissues. They submitted samples to the lab for identification, but decided to start him on chemotherapy right away.

Well, this was another loop in the roller coaster ride. The pathology report came back a few days later-no cancer! The mass was really an abscess, a bundle of walled off infection. So, this is good news, right? The neurologist put CJ on a long course of antibiotics and we all breathed a sigh of relief.

During the 9 weeks (!) of antibiotic therapy, CJ had good days and bad days. He still knuckled over quite a lot, and he lost more weight, really in the form of muscle atrophy from not using those hind legs much. His once glorious hair coat became thin and patches form surgery never grew back. He was extremely picky about eating-he just wasn't thriving. I attributed a lot to the stress of such a major surgery and having this big infection in his body, and his anorexia was likely due to the nausea from his antibiotics. He did start to eat much better when he finally reached the end of that long course of medication. We put him on some essential amino acids and increased his exercise/physical therapy to increase his muscle mass.

This is where patient advocacy really came into play. CJ's owners just never were happy with his progress, and didn't sit still when repeated queries to the neurologist weren't answered. They contacted the doctors at the state veterinary teaching hospital and got some interesting suggestions. Remember I told you that CJ had come from Arizona? Well, this neurologist had recently seen a patient that came from this area and had similar clinical signs as CJ. That dog had tested positive for a systemic fungal infection, rare in our part of the country but much more common in the south west. Yes, the tests were expensive-there were numerous fungi to test for. But we drew the blood and sent off the panels. Wouldn't you know it? CJ tested positive for the fungal organism that causes Valley Fever. It could very easily cause the granuloma-like lesion he had on his spinal column, and no antibiotic would resolve a fungal infection. We have asked the pathologist if it would be possible to go back and restain the tissue sample to try and identify the coccidiodes organism and in the meantime, have started CJ on a systemic antifungal medication. I chose one that is good for diseases of the central nervous system and has a lower incidence of toxicity-a problem with many anti-fungal drugs.

The diagnosis is a blessing and a curse. If it turns out to be the cause of CJ's symptoms-great! Hopefully the medication will get to the source of the infection, not easy to do in an encapsulated tissue walled off from the body like this was. It may take months or even years of therapy; systemic fungal infections are known for their tenacity. CJ could become toxic from the medication, developing liver issues if the medication can't be eliminated from the body. We will do periodic liver function tests and Valley Fever titers to monitor his response to treatment.

CJ's owners are so very frustrated about the perceived lack of help they got from their first referral doctor who seemed to dismiss their suggestions of this exact disease as a possible cause of CJ's problems way back in the beginning of all this. I am so impressed with their stick-to-it-ness and their sincere desire to do whatever it takes to help their boy. I feel fortunate to be working on their team, and really hope CJ is finally on the road to health.

Peace,
DrReneigh

Rub a Dub Dub, Tazzy in a Tub

2009-02-26T10:30:00.000-08:00

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.

Peace,
DrReneigh

Look What We Did for Lunch Today!

2009-02-23T16:06:00.000-08:00

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!

Peace,
DrReneigh

No More Jumping

2009-02-20T15:22:00.000-08:00

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!

Peace,
DrReneigh

In or Out?

2009-02-19T15:31:00.000-08:00

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.

Peace,
DrReneigh

When Organs Go Bad

2009-02-18T11:18:00.000-08:00

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.

Peace,
DrReneigh

One More Abbreviation

2009-02-10T21:05:00.000-08:00

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!

Peace,
DrReneigh

Spartacus Ain't Doin' Right

2009-02-09T12:24:00.000-08:00

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?

Peace,
DrReneigh

Maybe We Will Try Rogaine....

2009-02-06T13:58:00.000-08:00

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.

Peace,
DrReneigh

I'm Hungry!

2009-02-05T13:28:00.001-08:00

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.

Peace,
DrReneigh

When You Need to Show Your ID

2009-02-04T12:03:00.000-08:00

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:

AVID

HOME AGAIN

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.

Peace,
DrReneigh

Want to Watch a Spay?

2009-02-03T14:17:00.000-08:00

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.

Peace,
DrReneigh

Doesn't All Poop Smell Bad?

2009-02-02T16:11:00.000-08:00

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.

Peace,
DrReneigh

A Big Lump of Fat

2009-01-30T12:51:00.000-08:00

Scooby is an older Rottweiler, and as such, had a few problems to deal with today. She has always been a little lame on her hind legs, off and on for years, attributed to likely hip dysplasia so common in the breed. Lately she has actually been holding her left hind leg up, not putting weight on it at all if she could help it. Because of her age, visions of Chloe and her bone cancer came to mind, and I sure didn't want to go there.

Scooby also had a very large mass or lump under the skin over her right shoulder. It has been there for some time, but because she is shifting so much of her weight to her front end (a normal dog will carry 70% of their body weight on their fore limbs-Scooby, with her painful hind limbs, was likely carrying 80 or 90%) this large mass was starting to inhibit the range of motion of her shoulder. It was harder for her to get up and down-and at almost 100 pounds, it would be very difficult for her owners to help her. We needed to find out what this mass was before we could decide what to do about it.

An FNA or fine needle aspirate is a test we can do right in the exam or treatment room of the hospital. It only takes a few minutes on a cooperative patient. We take a very small guage needle, thinner than those typically used to administer vaccines to pets, and aspirate or "suck" cells or fluid or other material from the mass. This material is then put on a microscope slide, it may or may not be stained, and is examined for identification of the type of tissue comprising the mass. In Scooby's case, we aspirated a thin, clear, oily material-fat. Scooby had a giant lipoma or fatty tumor.

Lipomas are very common soft, moveable, round lumps under the skin. They usually don't bother the pet-owners only notice these lumps when they are petting or grooming the pet. They are benign masses, not metastasizing or spreading to other organs in the body although it might seem like they do since pets can get many of them throughout their lives. Verbal has quite a few of these lipomas, most on her ventral or lower chest and belly, but they can occur on legs and tails and even internally in animals as well as people. They are more common in middle-age to older animals, and over-weight females may be pre-disposed to them. Cats and younger dogs can certainly get them, too. Any new lump or bump on your pet should be evaluated by your veterinarian, even if it looks and feels just like a previosly dignosed lipoma, since they can mimic more serious cancerous masses such as mast cell tumors. An FNA such as we performed on Scooby, or even a biopsy may be necessary.

Large lipomas like Scooby had can be very vascular masses, having numerous large blood vessels which make the surgery more of a challenge. It was important we knew what her metabolic status was, the functioning of her organs before anesthesia as this was likely to be a long procedure. We also wanted to know just what was going on with her hind limb lameness and whether it was a treatable or just manageable condition. It would be awful to put her through a big, traumatic (and expensive) surgery only to find she had a malignant bone tumor or something. Thankfully, that wasn't the case for Scooby. She had pretty severe degenerative joint changes in both of her stifles (knees) and both of them had excessive "drawer" motion. By now, reading this blog regularly you know what that means-Scooby had long-standing ACL or anterior cruciate ligament ruptures. Her hip, which her owners always assumed were the source of her pain, were just beautiful on those x-rays! No signs of arthrits or degenerative joint disease there, no remodeling of the femoral heads, good seating of the "ball" into the "socket," and most important, no evidence of bone cancer.

Now Scooby's owners want to do what they can to help make her comfortable but unfortunately won't be able to afford knee surgery (much less two of them) for her. They haven't tried any joint supplements or NSAIDs, let alone narcotics, so we can set her up for our "multi-modal" analgesia plan, just like I have Verbal on. This morning we did the surgery to remove the large lipoma-and it was quite a procedure. There were lots of vessels as I had suspected, but it was also very invasive in the adjacent tissues, seeming to grow into the muscle and fat layers and even right on the ribs themselves. I don't like these "infiltrative lipomas" because it is very difficult if not impossible to be sure you removed all of the abnormal tissue, thus making recurrance likely. Lipomas regrow in about 50% of these cases. It is possible to do adjunct therapy such as radiation to inhibit the regrowth, although this is very expensive. Chemotherapy is useless for infiltrative lipomas. At least we have "de-bulked" the mass, allowing for freer, more normal function of Scooby's shoulder as she puts more and more weight on her front legs. And we are left with a big lump of glistening white fat-anyone for a reverse liposuction procedure?

Peace,
DrReneigh

Hoards of Pets

2009-01-29T13:20:00.000-08:00

There was a recent local case of horrendous animal abuse and neglect, truly defining the words "puppy mill." It has tugged at the hearts of many of my clients who are very responsible pet owners, taking on only the amount of dogs, cats, even horses that they can actually afford to keep-understanding this means not only food (which is expensive these days!) but regular veterinary care as well. Even though it is hard to do, these types of owners also budget for the unexpected, when illness or injury befalls their pet as it did for Mikey yesterday. Yep, even I am in that category-you know I have the opportunity to acquire so many hard luck cases but practicality keeps me from doing so. When Verbal faced cancer 2 years ago, we had to juggle our finances and did just that to confer with the specialists and provide the radiation therapy that probably saved her life. I sure realize not all owners are able or even want to go to these lengths, but keeping things manageable is only fair to the pets.

Animal hoarding can actually be a form of mental illness, and as such, not being trained in counseling or therapy, we are not usually capable of effectively dealing with the people involved in these cases. You may know people who adopt every stray pet they come across, who claim to "rescue" abused animals from terrible situations, and do so over and over. They don't hesitate to offer to adopt a new animal, even several animals at once, and don't give consideration to the amount of time or expense these new additions will require. They don't ever have outside people over to their homes, and they may have windows that are papered or otherwise blocked out. It isn't uncommon for them to try medicating animals themselves with products bought at a feed or pet store before seeking veterinary care. They may have relationships with several different veterinary practices, but rarely follow through with care recommendations for pets brought in-often asking for medication for other pets that have symptoms "just like this one."

While this might not be overt animal "abuse," it can certainly be deemed "neglect," and as such, we can't ignore the situation, as tempting as that may be. An immediate call to law enforcement may be appropriate in some cases, especially if care recommendations are declined for an obviously suffering pet. Animal control officers will do the evaluation of the situation-we can feel safe in reporting suspected cases anonymously if needed, and it isn't our job to determine "guilt" or "innocence" of the charge. If the suspected hoarder is a friend or a once good client who has changed over time, working with that person may be OK.

If you decide to work with a suspected animal hoarder, you must develop a relationship with that person. It requires a slow, cautious, respectful approach and gradual building of trust. Show yourself to be trustworthy and honest, reliable and predictable to that person or they will likely shut you out. In conversation, see if this person has any concerns about their pets and if they have any plans already for constructive action. The best way to help make a plan is to see the home setting-offering to come over and establish a care plan is a good way to start. Avoid suggestions of getting rid of any animals until trust is established, but do make part of the plan "no new animals." Always demonstrate genuine concern for the pets and the person-but don't be judgmental. That sure can be hard to do.

If you just aren't able to build that kind of relationship, talk to an animal control officer for advice. They may have a history with that person, often with a different species of animal. Sometimes you can use the officer in a "good cop/bad cop" scenario-they will insist on the care conditions and you can be kind and compassionate and offer help in the plan.

There is nothing wrong with you having a big heart and wanting to help the animals in a crummy situation like this. It may mean that having an on-going relationship with this person will allow you access to the animals and ensure continued care. It could result in a big "bust" as happened with the tragic situation in the news with the hundreds of affected animals. Your big heart is fine just the way it is, open, generous and compassionate. Your eyes may be the only witness to the suffering of animals in need, and your intervention may be crucial in saving their lives. And be sure you keep your own animal family number manageable.

Peace,
DrReneigh

Mikey's Big Spleen

2009-01-28T13:38:00.000-08:00

Mikey wasn't feeling well. (Isn't that usually why critters come for a visit to the vet?) His owner said he just wouldn't eat, he was restless, acting like he couldn't get comfortable, and he was kind of crab-walking-hunched up and walking almost sideways. More importantly, he was hurting somewhere-he was crying when he was touched, even just lightly petted. Being part German Shepherd, he isn't known for being an overly brave dog (oops, I'm perpetuating a stereotype here, but it is silly how those fierce-looking, big, sturdy dogs can also be the biggest wimps!) When I saw Mikey, I quickly discovered this wasn't him just being wimpy. He didn't cry when I palpated his neck or spinal muscles or examined his legs, but he cried loudly when I barely touched his ribcage and belly.

Mikey's owner was pretty sure he wasn't the kind of dog to eat something he shouldn't have like a stick or rock or something, but an intestinal or gastric (stomach) obstruction and maybe perforation certainly could cause these symptoms. Pancreatitis or inflammation of the enzyme-secreting pancreas can often be very painful and very serious. Mikey was getting to be an older dog, so neoplasia or cancer had to be considered, too. He was just too painful for me to palpate or put pressure on both sides of the abdomen and feel for abnormalities, so we decided to run some blood work and do some abdominal radiographs. I didn't see any obvious obstructions or a large volume of free fluid on the x-rays, but he was a big dog and I felt he could be hiding things pretty easily-we sent the films to the radiologist for review. Since he hadn't been drinking well, Mikey was a little dehydrated. We gave him some fluids with electrolytes under the skin to tide him over until we could get some test results back and sent him home for the night. Fluids alone often make many ill pets feel better right away. This wasn't the case for Mikey.

The next morning we had the blood results back-there was a very minor anemia and that was all. The rest of his blood work was essentially normal. This is good news, but frustrating since, when we called to check up on our patient, Mikey was even worse, and we had no real answer. I did not feel that the degree of anemia was enough to be causing his extreme symptoms, but it was leading us in the right direction. We called the radiologist and put a "STAT" on his report; we ordinarily close early on Wednesdays and didn't believe he could wait for answers. Mikey's owners were very worried, so we had them bring him back in to the hospital while we waited for test results. We wanted to start him on IV fluids and pain relief medications at the least.

Dr. Root, our radiologist, called right away. He thought there might be some loss of detail in the abdomen which can be a result of free fluid or motion from breathing efforts. He thought the spleen looked enlarged, and when he learned of Mikey's symptoms, especially the extreme pain, he thought peritonitis or infection in the abdomen was possible. Dr. Root believed Mikey was a good candidate for an exploratory laparotomy-a surgery to open up the belly and go search for the cause of the problems. I really like exploratories because along with discovering the cause, I am always hopeful that we will find a "cure" as well, something to fix or remove to alleviate the pain or the cause or source of the infection, tumor, or swallowed thread as happened to Bunny a few weeks ago. I decided to get another piece of information first-to find out if there really was fluid in the abdomen, and if so, what type. Mikey's belly felt fuller today and had a "wave" feel to it. Peritonitis can have purulent fluid, pus, bacteria and white blood cells. An enlarged spleen could be due to cancer and rupture of a tumor, therefore blood was a likely fluid. Organ dysfunction can cause clear white or straw colored fluid. We made a quick prep of Mikey's belly and a thin needle was inserted in the caudal abdomen so as to try and avoid hitting the enlarged spleen itself. There was pure blood-a lot of it. We took some quick x-rays of his chest to rule out obvious metastasis or spread of cancer to the heart or lungs, and these appeared fine. Mikey was going to surgery.

It was unlikely given his symptoms that Mikey's bleeding happened suddenly. Since his body has sort-of acclimated to it, he wasn't in immediate need of a blood transfusion from a donor dog. This could change, of course, given the type of surgery I was anticipating, a splenectomy. The spleen is a highly vascular organ, comprised of lots of winding blood vessels and packed full of blood cells. In fact, it acts as a reservoir of blood cells, there to be "squeezed" out in times of need, such as when blood is lost if a dog is hit by a car. The spleen also filters the blood, removing older red cells from circulation, ensuring only vital, healthy red cells that can carry oxygen are cycled through. The spleen also removes parasites that might be present in red cells or entire cells if they are diseased. It also acts as a lymphatic organ, draining material from local areas of the body to the regional "lymph node-like" spleen, stimulating it to react or swell along with the rest of the immune system and the antibody producing lymphocytes. Now, Mikey would also have plenty of red cells in his bone marrow-he could do just fine without his spleen if it was found to be diseased, cancerous and/or hemorrhaging. It would just be a big stress to his body to remove it, and thus the potential need for a transfusion.

When I first cut into Mikey's abdomen, I realized he had been bleeding much more over night than the x-rays taken just yesterday had shown. Blood literally flowed out of the first small incision. I attempted to hold the edges up and contain the blood and instructed my nurses to collect it in an aseptic (very clean) manner, thus allowing us to perform an autotransfusion-we were going to give the blood right back to Mikey, but we were going to put it back where it belonged-in his veins. It took numerous syringes and 2 large collection bags with anticoagulant in them, and my fingers were stressed to their limits holding his abdominal wall edges up and open to keep the blood from spilling out while we collected it. The entire time we also monitored his anesthesia levels, blood pressure and oxygen carrying capacity-he did great! The collected blood was then put through filters before it was given back to him, slowly at first to be sure there would be no reaction. His hematocrit or packed cell volume, the percentage of blood cells in relation to the fluid portion of blood, never wavered during the day-this autotransfusion seemed to be a success.

Mikey's spleen was, indeed, really big. More importantly, it was covered in purple to black, ulcerated and bleeding various sized masses all over the spleen as well as through out the omentum supporting the organ. This is a common finding when the nodules have ruptured and blood clots or cells have spread, possibly metastasized. You can't know just by looking which this is, clots or metastatic disease, but I did my best to remove all affected tissue, knowing microscopically this wasn't likely. I knew that to have a chance, Mikey had to stop actively bleeding, so removing the source was necessary. We were set up to biopsy the tissues and then consult with oncologists for further plans to combat the cancer if that was the final diagnosis. The spleen was taking up a lot of space so it was difficult to visualize the rest of the abdomen clearly; I did find a large mass on a liver lobe-not good. It was the same color and texture as the splenic nodules-and it peeled away from the liver tissue, leaving an oozing crater. I used some hemostatic "styrofoam" to plug up the hole, but advised the owner by phone of the problem and the seriousness of the likely spread of the disease. She understood the situation and elected to be as aggressive as we could be right now-it was likely the only chance to save his life.

I mentioned how vascular the spleen is inside-well, it is just as vascular on the outside. Many large, tortuous vessels supply and drain the organ and the affected omentum, so I did quite a lot of ligating. When it was removed, the abdomen looked so much happier! Apart from the single liver mass, there was no other obviously affected organs. I took samples for microscopic examination to confirm this, but with no more bleeding and no distorted, tumorous masses, Mikey's belly almost looked-normal. I sutured his abdomen closed in 3 layers and we woke him up.

Because of his good pre-operative analgesia or pain relief medications, Mikey woke up very smoothly-quiet and comfortable in his warmed blankets. He had received all of his own blood and some additional IV fluids for support, as well as some prophylactic antibiotics. We helped his owner transfer him to her car so she could take him to the 24 hour care facility; after going through such a major procedure I didn't want him spending the night by himself, even if I could look in on him frequently. I knew he would be in far better hands having a critical care doctor on hand through out the night. My staff wrapped up everything after staying late for Mikey today. They knew how important this was to Mikey and his very scared owner, and to me to be able to provide this service for them. I couldn't have done it without their dedication and kindness in giving up their only free afternoon this week. Way to go Amber, Kayla and Terra. You are awesome nurses.

We aren't out of the woods yet. Mikey needs to get eating and drinking again and we have to be sure all the bleeding has stopped. Then, of course, we have to wait on the pathology report to identify the source of the masses. It is very likely they are a hemangiosarcoma, the malignant neoplasm of blood vessels. We could get lucky and the diagnosis could be hemangioma, the benign form. We will consult with the veterinary oncologists once we have the diagnosis and work together on the next step of his treatment plan. I have said more than a few prayers for Mikey and his owners, asking that he recovers quickly and that his owner can rest well knowing she has done everything possible for her friend in a really crummy situation. He is so well loved-that, and a belly free from a big bleeding spleen, is all that he needs tonight.

Peace,
DrReneigh

Caution, X-Rated Blog

2009-01-27T16:45:00.000-08:00

Yep, usually this blog is family-friendly, no more x-rated than Animal Planet or Wild Kingdom shows. But today a 115-pound Malamute named Raven came to see us with a rather embarrassing problem, one it might be a bit delicate to talk about around the dinner table.

Have you seen those commercials for ED (erectile dysfunction) treatments for men, you know the ones where they mention calling your doctor if you experience an erection lasting longer than 3 hours? Yea, right you think. Dream on. Well, it isn't as glamorous as you might think. Just ask poor Raven. No, he wasn't taking any Viagra or Cialis as far as I know, but he had the reason to call his doctor all right. OK, his owner is the one who called, frantic as she came home to find her dog miserably licking at his "private" area and noticed that his penis was extruded from the normal sheath (skin) covering and trapped outside of it, very red and swollen. This is called paraphimosis, and is different from priapism, which is a state of continuous erection due to a neurologic anomoly. Raven is a neutered male dog, so his owner wasn't expecting to see what she perceived as overt sexual behavior in him. Little did she know, boys will be boys.

Causes for this very uncomfortable condition can be excessive hair in the area, which can cause a ring around the base of the penis and subsequent constriction of the blood vessels, neurologic disease, trauma to the organs, or sexual stimulation/masturbation. Sometimes we don't know the cause, but finding a cure-quickly-is pretty darned important for the affected pet.

If the situation has just occured, there is likely little pain involved. Cleaning and some lubrication with K-Y jelly is all it takes to put things right. But if the tissues are very swollen and raw from being licked and dried out, as was the case with Raven, sedation and some good pain medication is the way to go. We gave Raven both of these right off so we could better evaluate the situation. He had traumatized the tissues and the circulation had been cut off for some time. Once he was relaxed and after some gentle cleaning and lubrication, we were able to replace the tissues fairly easily. He did have a ring of hair around the base of the penis, so this was the likely cause of the whole situation. Since he had done a fair bit of damage with his licking, we decided to put him on some antibiotics and anti-inflammatory medications for a few days, as well as make sure he stays in an e-collar to prevent further self-trauma. His owner will have to watch him for any furthur episodes, and be sure to keep him well groomed to decrease the chance of all that hair building up in the area. I also instructed her to make sure he was urinating normally.

Raven was lucky-just sedation and lubrication was all it took to put things right. Other dogs have needed surgery to correct strictures, to make room for the swollen tissues, or even to amputate damaged penile tissue, especially if the situation occurs repeatedly. I thought it best not to include pictures today, at least not of the anatomy we are discussing. I'm sure you can Google the topic if you want more information. Just think of Raven when you next see one of those ED commercials and be glad he turned out OK.

Peace,
DrReneigh

How NOT To Go Down Stairs

2009-01-26T13:59:00.000-08:00

Elwood had a big "oops" last week-he fell down some stairs and came up lame on a hind leg. He wouldn't put any weight on it at all. His owners felt terrible seeing him like that, so brought him in to see us.
Now remember when I said that all hind limb lamenesses are due to injured cruciate ligaments until proven otherwise? In Elwood's case, we proved otherwise pretty quickly. He was so painful, that a good examination of his affected leg just wasn't possible with him awake, so we made sure he was stable, listened to his heart and lungs and checked the color of his gums and all. It appeared that all we were dealing with was that hurting leg. We quickly got some pain-relief and sedation medications into him and I proceeded to examine him more thoroughly. No thorn in his paw, no torn toe nail. I worked on up the leg, really concentrating on the stifle (knee) of course, but it was very stable and was not hot or swollen. None of the long bones felt unstable or were visibly poking through the skin-so no obvious fractures were evident. But when we got to his coxofemoral (hip) joint, it just wasn't as flexible as his opposite one was-we couldn't extend it completely. Hmmm, it was looking like that knee just wasn't the problem after all.

Next we decided to take some x-rays of his pelvis and knees to be complete and hopefully discover the cause of his coxofemoral joint decreased range of motion. The answer popped right out at us-Elwood had a luxated (dislocated) hip joint. Ouch! No wonder he wouldn't put weight on it. I was so glad we had given him a hefty dose of pain medication. He sure needed it. We called his owner and told him the story. Elwood would need to be anesthetised (sedation just wouldn't cut it) so we could reduce or replace the femoral head (ball) into the acetabulum (socket.) Of course they agreed and we proceeded to do that right away.

Elwood wasn't a large dog, thank goodness. He was a Cocker Spaniel, a little less than 30 pounds. In large dogs, reducing a hip luxation can be HARD work, and even in a 30 pound dog, I could expect to work up a little sweat. We anesthetised Elwood and placed him on a padded exam table. We then placed a cotton rope around his groin and had one of our assistants hold on to this for traction against me for when I started to pull. I didn't want him coming off the table! Another nurse held his head and endotracheal tube (breathing tube) in place.

There is a bit of an art to reducing a luxated joint. This is where the little bit of physics we learned so long ago comes in handy. It is also important to have both radiographic views of the hip to see just where the femoral head was in relation to the socket. Most luxations result in a dorsal and cranial position of the ball and this was the case with Elwood. I used one hand to put pressure on the ball (through the skin) and would attempt to guide it back where I wanted it-up and over the rim of the acetabulum (socket.) I used my other hand (and whole body, really) to rotate the femur outward and down-praying for that tell-tale "pop" when the ball happily returns to its normal position.

It took quite some time to get Elwood's muscles loosened up, but when we did, the "pop" came and the hip was back to normal. It instantly flexed and rotated normally-just like the opposite, healthy leg. We took a post-reduction x-ray just to confirm this and-nope-it wasn't in place. Rats! Sure enough, when I palpated the joint area, I could feel the ball out of the socket, plain as day. It either never went in completely and the "pop" was something else entirely, or the ball had re-luxated when we transported him to the x-ray room. Not good. This time when I made the motions to reduce the joint, I felt how easy it really did "pop" and how just as easily "popped" right back out. Double rats! This meant there was likely damage to the rim of the acetabulum, maybe even a congenital defect making the socket just too shallow to contain the femoral head with out the strong ligament attachment which had ruptured during Elwood's fall. So now what?

Elwood was going to need surgery to correct his dislocated hip. There is no wrap or sling that is strong enough or that offers enough support to keep a dog's hip joint stable for the time it would require to heal. If possible, it could be reduced and a band of heavy duty suture or wire could act as a sling internally, trapping the ball in the socket. Not all injuries can be repaired this way, especially if there is a congenital defect like a shallow acetabulum as I suspected was the case for Elwood. I recommended that Elwood have a procedure called an FHO-a femoral head and neck ostectomy. In this procedure, the femoral head and neck are actually removed, thus removing the object that is causing the bone-to-bone contact and thus the limitation of movement and the extreme pain.

Wow! That sure sounds dramatic, doesn't it? How would a dog be able to walk if his leg wasn't connected to his body? Well of course his leg is still connected-there are numerous very strong muscles in the thigh and buttocks that support the hip. The body will shortly form a sort-of false joint, one with no arthritis and no pain since there is no longer any bone-to-bone contact. My dog Verbal had this surgery done when she was quite young due to her terrible hip dysplasia in the affected limb. It is often considered a salvage procedure, but I really consider it to be a good choice for many dogs, especially young, active dogs. After recovering from the initial pain post-operatively, we encourage the clients to get those dogs moving-no cage confinement and strict rest as is the case with so many other orthopedic surgeries. We want the muscles to strengthen to support the hip, not atrophy from disuse. We will give instructions for physical therapy and get these patients started within a week or two after surgery.

I have done numerous FHO surgeries over the years and have always been happy with the outcome. A rare dog may need a second surgery if a portion of the neck remains and interferes with motion as the dog starts to bear more weight. Elwood's owners elected to have his surgery done at a veterinary surgical specialist facility since they could do the surgery that day and we would have had to schedule him for the next day. They just wanted him on the road to recovery as soon as possible. I received a report from the surgeon this morning and it sounds like Elwood's surgery went very well. He is home and his owners are pleased that he is already starting to touch his toes to the ground. What a trooper! I'll get the privilege of following up on his post-op care since the surgery facility is a much longer distance away. It is a shame this happened to poor Elwood, but he is fortunate to have devoted humans who are caring for him so well. He's already up and around, on good pain medication, and we'll have a discussion soon on how NOT to go down stairs in the future.

Peace,
DrReneigh

A New Family Member

2009-01-23T09:39:00.001-08:00

This is exactly the kind of appointment that everyone who ever wanted to be a veterinarian thinks of-a healthy, happy brand new puppy. Snickerdoodle is a 3 month old Havanese and Poodle cross-as cute as a bug and has never met a human she didn't instantly love. It's a good thing she can't run out of kisses-she doles them out fast and furious, interspersed with some "tastes" with those needle teeth. Doodle is filling the shoes (paws) of her owners first dogs who both passed away at 16 years of age. If this is any indication, she will have herself a lifetime full of love and care-just what every new puppy needs and deserves.

When we schedule new puppy or kitten visits, we make sure the new owners have a good chunk of time, at least an hour, that they can spend with us. We want to ensure we get the opportunity to go over all the basic care instructions, especially if the humans have never had pets before or, as is the case with Snickerdoodles owners, it has been a long time since they have had a puppy to raise. Their geriatric dogs just didn't have nearly the level of energy and "got things to do" as this new family member does. As is often the case, every staff member plays a part in a new puppy or kitten exam.

Receptionists of course get to book the first appointment and greet the proud new owners. They find out where the puppy or kitten was found or purchased as there can be certain issues that crop up as a result of coming from a shelter or a pet store for example. "Back yard breeder" or puppy mill dogs also have their own types of challenges to over come, and knowing their source is important for their management. Receptionists will also give the owners some information on the puppy or kitten "plan" we offer which bundles together all the early exams, vaccines, deworming and other getting started procedures. Clients who opt for one of these plans also receive a discount on their pet's spay or neuter when the time for that surgery comes around.

An assistant or technician will usher the family into an exam room and start by getting a weight on the pet. It will be important to monitor their weight as they are growing up, ensuring they aren't too thin and possibly parasitized or undernourished nor getting too fat and possibly stressing those growing joints. The assistant or technician takes 20 to 30 minutes thoroughly discussing everything from potty training-a very important subject!-to feeding and nutrition. They will talk about the various diseases we want to vaccinate against and when we will do so, explaining immunity, booster vaccines, etc. Deworming and flea control, along with zoonoses or diseases humans, especially children if they are present in the family, can pick up from the pet are mentioned and then often the first doses of preventatives are given. Basic vital signs are taken and any health problems are noted.

The puppy or kitten may be taken in the back to collect a sample of feces, do a skin scraping or microscopic exam of ear debris if indicated, or draw blood for viral testing. Our hospital attendants help restrain the wiggly critters, ensuring this is a gentle procedure with lots of treats and reassuring. We sure don't want them remembering this place as bad or scary-they will be coming to see us throughout their lives and we want to start them off right.

Next comes the veterinarian's part of the visit-that would be me. I will introduce myself to new owners and/or congratulate others on the new family member. I will do a thorough health exam on the puppy or kitten, eating up the wiggly kisses or purrs. I am so glad I can get my "fix" at work and don't have to take everything home. I try to fill out a health report card so owners have a record of the exam and any notes of problems or issues we discussed. Sometimes there will be an umbilical hernia for example-we will note this and plan to repair it at the time of the spay or neuter. I do my best to answer any questions that come up, often referring owners to web sites I trust or trainers we work with. Finally we pop in those icky vaccines and discuss what to watch for in case the pet has an adverse reaction to them.

The assistants or technicians then wrap up the appointment, making sure the owner's have had their questions answered, have all of their samples and literature to refer to later, and be sure they know how to reach us if other questions arise. Receptionists will take care of the money part (yep, I have to pay my staff and suppliers, too) and arrange for booster vaccine appointments. I always make sure owners know to stop on in anytime they are out and about with their pets, just coming by for a social visit-cookies and kisses-so they won't associate us with just thermometers and shots and all the "bad" things. We want our patients to love coming to see us, and most of them really do. Then the new family is good to go.

New puppy and kitten visits are highlights of the day, making up for emotional euthanasia appointments or crummy diagnoses of cancer and all. Happy, busy puppies and kittens just don't have time to be sad. They live for the moment-and if they are lucky like Snickerdoodle, that moment is always wonderful.

Peace,
DrReneigh

A Wealth of Knowledge

2009-01-22T20:48:00.000-08:00

Yesterday's blog about specialists was pretty timely. One of those local specialists, Dr. Sullivan, who is a veterinary ophthalmologist, very graciously took the time tonight to share with a room full of general practitioners some pearls of wisdom from his field. He talked about some of the more common eye conditions we might see in practice and those that warrant referral. There are some newer medications and surgical procedures available, and the videos he showed of some of those procedures were pretty darned cool. Little endoscopic instruments inside a dog's eye, repositioning a detached retina-absolutely amazing. Eye surgery isn't just for your Grandma anymore.

I am very fortunate to have had the opportunity to hear Dr. Sullivan talk tonight. Things change rapidly in the veterinary medicine field, so I welcome the chance to learn whenever I can. Did you realize that continuing education is actually a requirement of the licensure of veterinarians in our state? It isn't much-40 hours of classes every 2 years-and a veterinarian is required to keep their own records of those classes. I know that there are certainly ways to skirt around the requirements for those who are too busy or don't believe in the necessity of those requirements. But I believe it is an attempt by the licensing board to ensure that its doctors remain as current as is possible in their knowledge and skills. I, for one, am glad of the requirements and routinely acquire several times the required number of credits for my benefit and for the sake of my clients and patients. I cherish every opportunity to learn and better myself, and encourage that attitude in all of my staff members as well.

Opportunities for CE come in many forms. Drug companies and suppliers often sponsor them by arranging a dinner and providing the speaker as was done for Dr. Sullivan tonight. We often schedule "lunch and learn" sessions in our hospital on specific topics like flea control or prescription diets. Large conferences where numerous lectures and laboratories are offered are held in various locations all over the world, literally. Attendees might combine learning with skiing in Colorado or snorkeling in Hawaii for example. Oh, that snorkeling sure sounds good about now, doesn't it?

Even though it isn't required for them, continuing education helps every staff member in their respective jobs. It adds interest for them, increases their personal skills and knowledge, opportunities for advancement, and supports the rest of the team. Since not everyone can go to every available class, nor has the interest to do so, we usually ask those who have recently attended a class or seminar to share the information with the others at a staff meeting or through handouts they might put together. I really believe in sharing the wealth of knowledge-it does wonders for our team spirit, and can only benefit our patients.

Peace,
DrReneigh

Those "Special" Cases

2009-01-21T15:23:00.000-08:00

Wow. None of my blogs have received the kind of response I've gotten as yesterday's "Loser Humans" entry did. Well, maybe the one when we learned that Lucy was killed, but Sunshine's story hit a nerve with my readers and I got quite a few calls and emails today asking about her. You know I wouldn't have euthanized her unless she was terminally ill, or sent her away to be killed. But I really don't want it to get back to those heartless people who abandoned her just what did happen with her. I know, I know, they COULD have left her on the streets to fend for her self. They COULD have taken her to the pound. They must in their heart of hearts want a better life for her. Fine. I just HATE being used this way, when anyone who knows me KNOWS I would have helped if just asked. Thank you to every body who is asking after her and thanking my staff and me for her sake. She is a sweetheart and although scared to death yesterday, has really come around today with just a little tender loving care.

Veterinary medicine is wonderful in that general practitioner veterinarians like me (somewhat similar to family practice MDs-they are just limited to a single species!) are able to see and handle a wide variety of patients and cases-limited really just by their interests and experiences. It allows for a wide variety of situations-there is rarely a dull moment around our hospital as you just don't know what might come about when that phone rings. I love being able to examine a patient, do any necessary tests right in my own hospital, and often do major surgery or dental work, manage infections, control pain, provide behavior consultations-"all in a day's work" as I've written about before. Since the knowledge base is so huge-and seems to get larger every year-there is always talk of "tracking" veterinary students, limiting their training to large or small animal species for example. But I continue to support the type of training I received-"all creatures great and small." I may not do as much large animal work these days-the small animal work takes up a lot of time-but my time working on cows and horses and all gave me confidence and experience-and lots of stories!-which will follow me throughout my career.

As you have been reading along in these blogs, you have likely noted when a patient requires attention above and beyond what a general practitioner (me) is able to provide. There are many veterinarians who elected not to concentrate on a certain species, only seeing cats or birds for example, but rather specialized in a given area of medicine or surgery. Most of these specialties require additional years of study or internships, then the passing of difficult tests or boards, thus the term "board-certified" in describing a specialist. We are fortunate to live near a large metropolitan area and have many of these board-certified specialists available for our patients without having to travel great distances. Of course, the additional training and equipment specialists and their teams require come at a cost-referral or consultation services can be expensive, and some of our clients may not be able to afford this option. If this is the case, I will provide the care that I have been trained to do, often with the advice of experts I consult online. Although clients are made aware that specialists are often more qualified for given procedures, I will do the next best thing for the pet when their are cost or other limiting factors. I happen to enjoy surgery and other challenging medical cases, so these situations add excitement to the day, allowing me to stretch out my skills and keep my team hopping.

I believe we have specialists from every board represented in our area. Dr. Matson is a veterinary dental specialist: Eastside Veterinary Dentistry
Dr. DuPont is at Shoreline Veterinary Dental Clinic. Dr. Karri Meleo is a veterinary oncologist or cancer specialist. Dr. Sullivan and Dr. Landry are ophthalmologists or veterinary eye doctors. Dr. Duclos specializes in dermatology or skin and allergy problems: Animal Skin and Allergy Clinic
Dr. Mison is a boarded surgeon: Seattle Veterinary Specialists
Dr. Wackerbath is at the feline hyperthyroid treatment center: Feline HTC
Dr. Woodfield is a board-certified cardiologist or heart doctor.
Dr. Sung is a veterinary behavior specialist. These are just examples of the many wonderful doctors we work with regularly-and are fortunate to do so.

Some of the specialists that supply their services to our clients and pets on a regular basis work in large group or specialty centers. They are often associated with critical care and/or emergency facilities, offering state-of-the-art veterinary medicine and surgical procedures. It is very handy to refer the very ill patients to these large centers as so many of them have more than one issue or problem. Having the ability to do an ultrasound, a specialized diagnostic imaging test, for example, interpret that test, do a biopsy, and continue on to surgery if indicated makes it much easier on the patient and client-not having to transport an ill and/or stressed pet, securing records and test results-everything is at hand and the whole team can work together for that pet. Two centers or facilities we commonly refer to can be learned about here:

ACCES

VCA

Pet lovers are more and more demanding higher levels of care for their furry family members. With veterinary specialists at the standby, our pets have never been in better hands.

Peace,
DrReneigh

Loser Humans

2009-01-20T12:55:00.000-08:00

I am really hesitant to write about the dog pictured here today-my staff is calling her Sunshine, but no one knows her real name. I am so angry about the situation that brought her to our hospital and me even mentioning her here just gives attention to the loser humans associated with her. Yes, I am being harsh with them and that just isn't usually my nature. But when it comes to the welfare of animals, I go a little ballistic.

When we came back from lunch yesterday, we found Sunshine tied to the picnic bench outside our back door. There was no note, no tags or microchip identified her-nothing. I know that times are tough, her so-called owners could have lost their jobs or have medical problems of their own. Did their property flood recently and they are now homeless? Maybe Sunshine has health issues too costly for them to deal with. She might not get along with cats and they have a beloved Persian or something. But how would we know any of this? If they had called and asked, we could have sent them to rescue groups (she appears to be a purebred Basset Hound) for help and advice. We could have utilized some of our Flake's Angel Fund money if they had made it known they were destitute. You know by now how my staff and I will go out of our way to work with people to find solutions to problems like these. But this act of abandonment, so passive aggressive and manipulative is the lowest form of human behavior. At this point I don't care what their "story" is. Can you tell this makes me just a bit crazy? Sorry. I guess I'm in a mood today.

Stories like this are unfortunately becoming more and more common in this terrible economy. We've seen a box full of kittens on the door stop in the morning or a new "client" claiming they forgot their checkbook after an appointment, running home to get it, only to never show up again, all phone numbers left as contacts being bogus. I've seen news stories about even bigger problems, people unable to afford their horses, can't sell them or even give them away. There are no longer any slaughter facilities in this country for horses (another story for another time and debate....) so people have actually turned their pets loose on government land, hoping they will be able to fend for themselves. So scary for those poor horses-just what are people thinking?

People must believe that leaving a once beloved pet (we hope Sunshine was loved at one time) at a veterinary hospital will result in a happy ending; veterinary staff love animals after all. But I have asked my staff to be responsible pet owners-that means not having more pets than they can afford to take care of and therefore are good examples to our clients. Personally, I have to do that as well. I can't take in every stray or unwanted critter as much as my heart tugs me to-I have pets of my own to care for, have a home with a mortgage, a business and employees I am responsible for. Drugs and supplies, food, utilities- everything is more expensive these days, and my suppliers aren't giving me any breaks; how can I be expected to?

I'm not going to tell "the rest of the story" about Sunshine simply because I don't want those humans to feel justified in leaving her here with us. They abandoned her, and don't deserve to know if she was euthanized, taken to the pound, or given to a family with 19 kids and loving humans who will care for her all the days of her life. They should have big tattoos across their foreheads that state they are no longer allowed to own pets, ever, because they can't be trusted to provide basic care for them. I know it can be embarrassing to ask for help when you are down on your luck-believe me, I've been there. But if it is for the sake of a friend, especially one who relies on you so completely as a pet does, well, you swallow your pride and just ask. Anyone who knows me and my staff knows we wouldn't judge the people who come to us and sincerely want to find a solution to a crummy situation. But you can bet we are "judging" these people....rightly or wrongly. Being judgmental isn't a great character trait to admit to having, but there you go. My dog still loves me :)

Peace,
DrReneigh

Max's "Drawer Motion"

2009-01-19T15:38:00.000-08:00

Little Max is a lucky dog. He and his buddy, Ewoki, get to go on walks and to the dog park all the time with their human and have a wonderful time doing that. This weekend, though, he over did it and came up lame on a hind leg-ouch! He was holding his leg up, not wanting to put any weight on it at all yesterday. He is a bit better today, touching his toes to the ground, but you can see that he is off his game a bit and so his owner brought him in to see us.

Do you remember reading about Charlie and his hind leg lameness on New Year's Eve? I said that when dogs are lame in the hind end, there are numerous things that could be wrong-anything from a thorn in the paw (wouldn't it be nice if they all were that simple?) to hip dysplasia (an inherited condition where the hip joint never formed correctly, resulting in a progressive, painful degenerative condition.) But there is one problem that is so common that we tend to say all hind leg lame dogs have this until proven otherwise. The problem is called ACL or CCL rupture-anterior (or cranial) cruciate ligament rupture or tear.

The ACL's "job" is to connect the top bone (femur) and bottom bone (tiba) and to stabilize the motion of the joint, keeping it from moving in abnormal ways. We know a knee joint should flex back and forth, but if the ligament is injured, the joint may have what we call "drawer" motion; the lower tibia will move forward as if you are pulling a drawer out of a desk or dresser. Drawer motion is abnormal and when it is present during an exam (done under sedation or anesthesia due to the pain of manipulation and because the strong muscles of the leg will hold the joint together in an awake animal) confirms the diagnosis of ACL rupture. Max had definite drawer motion in his affected stifle and no abnormal motion at all in his good leg. We then took radiographs during his sedation so we could see if there was any other problem like fractures or even neoplasia (cancer) that would affect the outcome of repair and recovery.

Once damage to the ACL was confirmed, we had to talk about repair-that meant surgery. For bigger dogs like Charlie, a trip to the surgery specialist is warranted to have a procedure called a TPLO or tibial plateau leveling osteotomy (see why we call it a TPLO?) Max only weighs about 13 pounds, so he could be a candidate for a different surgery, one we do at our hospital routinely, called a lateral imbrication procedure. In this surgery, heavy suture material, almost like fishing line, is laced along the side or sides of the stifle joint and mimics the function of the cruciate ligaments, stabilizing the motion of the joint. There should be no drawer motion remaining after these lateral imbrication sutures are placed. It is a good procedure, costs significantly less than a TPLO, and should have Max back to good weight bearing in a month or so.

We did get some x-rays of Max's stifle and saw a little piece of bone in the center of the joint. This is common in ACL ruptures as bone can come off from the point of attachment of the ligament and the joint surface. The radiologist will review the films, but the diagnosis is clear.

Max and his owner will go visit the veterinary surgery specialist for a consultation and get their recommendation for the repair of his injury. At his age (10 years) this is less likly to be a conformational issue and more a primary injury-I doubt he will have his opposite leg affected but since he is putting almost all his weight on that opposite leg, it is vulnerable to that possibility. He will be rested and put on anti-inflammatory and pain relief medications before and after his surgery. I said at the start that he is a lucky dog and I really believe that. He has a wonderful owner who is willing to take care of him, he has a good buddy, Ewoki, who watches out for him. And he has a great personality, seeming to realize that his veterinary team is trying to help him feel better-it sure makes us love our jobs all the more and want us to go out of our way to do what he and his owner need. In this case it means closing that "drawer."

Peace,
DrReneigh

"Just Say Cheese"

2009-01-16T09:01:00.000-08:00

I admit it. I don't like going to the dentist. I was "lucky" enough to inherit my Mom and Dad's crummy teeth, so a trip to the dentist usually results in the diagnosis of cavities, broken old fillings or worse. The staff at my dentist's office are nice and always try to make the visit pleasant, but it is usually painful and expensive-what's to like? I do make myself go regularly-I know that the preventive care will help ward off even worse dental conditions and possible systemic diseases.

Our pets are no different when it comes to the need for preventive orodontal care. Most people realize that unhealthy teeth or gums can be a source of pain or infection in a body, but few realize they can lead to problems with the over all health of the pet. Bacteria can enter the bloodstream of inflamed gums or through the roots of abscessed teeth and "seed" the filtering organs such as the kidneys and liver, resulting in significant damage and loss of function. This can certainly shorten lifespans, which we've already mentioned are much too short as it is. We want to do all we can to extend these lives, and good dental hygiene is a step in the right direction.

You really should be examining your pet's mouth once a month if they will let you do so safely. This is especially important in dogs who like to chew on hard things (we know rocks are a big "no-no", but some dogs do it anyway) and in older animals. We offer a free dental evaluation by one of our technicians or assistants and encourage clients to make a brief appointment for this important service if they have any questions about their pet's oral health. Start by smelling the breath-"dog breath" is never yummy (except for puppy breath, who can resist that?) but it shouldn't be really foul. This could be coming from accumulating food or periodontal or gum disease. Periodontal disease is very common in pets, caused by bacteria accumulating at the gum line around the tooth and can result in red, swollen or bleeding gums, the breakdown of the bone that holds the teeth in place, loose teeth and and ultimately in the loss of teeth. Periodontal disease can be prevented, but daily brushing is required to remove the offending bacteria. Anti-bacterial and/or enzymatic treats, pastes and rinses can also be used-but something has to be used every day to do any good.

When you are checking the mouth out, look for signs of broken or loose teeth-these may look irregular compared to the same ones on the opposite side or may be painful to the touch. The pet may be drooling excessively or may be pawing at their face. Some may get swellings of the cheek or even protrusion of the eye over the affected tooth. An empty spot where a tooth used to be may have been broken off and roots left behind. These are important to be assessed by your veterinarian as retained root fragments are often sources of pain and infection and much more difficult to remove the longer they remain. You may see a red or brown spot in the center of a broken or chipped tooth-this is the pulp or root canal-living tissue that once exposed, can be quite painful and possibly lead to infection.

Noting any masses or growths in the mouth or on the lips or tongue is an important part of the oral exam. These could be benign growths called an epulis, really just overgrowth of gum tissue, but only microscopic examination by a pathologist can tell for sure. Malignant or cancerous growths in the mouth are often very aggressive and early treatment/removal is essential for their management. Ulcers or wounds here may be symptoms of a systemic disease process.

Your veterinarian or technician will chart the mouth and every individual tooth will be identified just as our dentists do for ours. A probe is used to measure pockets of detachment of the gums
all around a tooth. This needs to be done under general anesthesia as part of the complete dental ATP-Assessment, Treatment, and Prevention plan. It is the only way to be safe and thorough-even the most well-behaved critter doesn't say "ahhhh" and let us poke around their mouth. Radiographs or x-rays, again just like they do for us, are taken (in hospitals that have the equipment to do so) and evaluated for the health of tooth roots and adjacent bony tissue. These are essential in determining the best treatment plan for the teeth or the need for extraction if the tooth cannot be saved (or restoration procedures are too costly.) As hard as it is to believe, most pets do pretty darned well without their teeth. Many don't even chew their food (as is evident when mine puke up their food on my carpet....) I'd probably have a few less scars on my hands and arms if some of my more aggressive patients lost a few of their "weapons."

It may be recommended that your pet visits a veterinary dental specialist if one or more dental conditions warrant it. They will have the equipment and training needed to provide the best care for your beloved friend. However it is provided, by you at home, your general veterinary practitioner or the dental specialist, it is simply important that we work together to ensure our patients are smiling for their next family photo-"Just Say Cheese!"

Peace,
DrReneigh

Goodbye, Little Friend

2009-01-15T14:40:00.000-08:00

Our feathered and furry friends live lives that are far too short for most of us; we are greedy and want them with us forever and ever. Even when they reach their senior years and die of natural causes, we sometimes feel ripped off, and when we are talking about our typical "pocket pets," guinea pigs, hamsters and such, that is particularly true. Little Tiki was a cute, chunky, squeaking ball of joy- a guinea pig who shared her life with one of my dear friends, Happy. Happy sent me an email today to let me know that Tiki had passed away, surrounded by her loving family. I know she had a great life, even though we might feel it was far too short. Her wonderful humans gave her just the right care and she had the essential companionship for a happy piggie with her buddy, Kona, and two Labradors (yes, the big dogs!) Opal and Meile. In fact, Opal and Meile gave her big sloppy wet kisses as she passed from this world. Tiki is at peace now, buried in a small, open area in her backyard where the sunshine can warm her from above. Such a little life can make a huge impact on the lives they leave behind.

The average guinea pig only lives about 4 to 7 years. While they are classified as rodents, these "cavies" are more closely related to porcupines and chinchillas than to rats and mice. Since they are generally very sweet-tempered, (rarely biting or scratching) relatively inexpensive to buy and maintain, and easy to take care of if you know the basics, guinea pigs make excellent pets. They are, however, one of the most allergenic animals-children or people with asthma or other severe allergies probably should avoid them. We commonly find short-haired or the English variety as well as the shaggy, rough coated Abyssinian (whose hair is often in a spiral or rosette pattern) and the longer haired Peruvian breeds-all in an abundance of colors and patterns.

These little piggies (no, they are NOT related to pigs or hogs) are not inclined to climb, so housing them in open-top cages with sides at least 10 inches high is fine, as long as there are no predators (hungry or curious kitty cats or dogs) with access to them. They do need room for exercise, though, so the cage should be at least 8 square feet per adult animal. Solid flooring is safest with wood or paper shavings for bedding. They shouldn't be in drafty areas, or in direct sunlight and room temperatures should be about 65 to 75 degrees F.

Solid, heavy crocks for food dishes are best so they can't be tipped over or chewed and result in sharp edges as plastic can. Free choice grass hay should be available, as well as fresh, clean water, usually via a water bottle. They tend to "back-wash" food particles into the tip of the bottle, so they need it cleaned and changed daily. Guinea pigs are known for their inability to manufacture their own vitamin C, so require a daily source of this in their diet. It is not enough to give it to them in their pellets as these quickly oxidize or age and can't be relied upon to provide the levels our pigs require. Pellets alone also make for very fat little pigs-a common problem of our house pets. Fresh veggies and fruits are the best sources of vitamin C, but vitamin supplements can also be given. I don't generally like to add things to their water for fear it will make them drink less than they should.

Guinea pigs live in groups in the wild-they are very social little guys. They do best if they are kept in pairs, preferably two females to decrease the tendency to fight, especially if the owner is away for long periods during the day. They really bond to their humans, often learning their voices and squeak excitedly when they come home.

It is possible to breed guinea pigs, but females must be bred about the age of 3 to 5 months. This allows for a 59 to 70 day length gestation and birth before the pubic symphisis or pelvis joint fuses. If bred for the first time as an older animal, (females are referred to as "sows" and males are "boars") the pelvis can't expand during delivery and dystocia or difficult birth results, usually requiring a c-section. Baby guinea pigs have what we call "precocious" development-they are born fully haired with their eyes open. They can walk and eat solid food within a few hours. They can reach puberty as early as 4 weeks, so young males and females should be separated so they don't breed too early.

Like most pocket pets, most of the more common guinea pig ailments are related to husbandry or management issues. Scurvy results when they aren't provided with enough vitamin C, and can develop rapidly. They can get distended joints, act achy, unthrifty, get diarrhea and not eat or move. Pigs get pododermatitis or bumblefoot, sores on the undersides of the feet, developing most commonly when housed on wire-meshed flooring, especially if the wire is rusted or soiled.

Alopecia or hair loss occurs will occur over the flanks and back in all sows in late pregnancy, and thinning of the hair over all will occur near the time of weaning. It can be a pathology when associated with stressful conditions, such as when the pigs are housed in very noisy area of the home, or when they are "watched" or teased by cats or dogs or other perceived predators. Poor diet, even "over nutrition", is a stressor, too. Guinea pigs will "barber" their hair or chew it off themselves or their cage mates. You can generally tell if it is self-inflicted or done by the other pigs due to the location of hair loss on the body-can the pig actually reach that area on their own? Skin mites can be transmitted through bedding materials or by contact with infested animals. These can be contagious to other animals, even humans.

Ptylism or excessive drooling is often referred to as "slobbers." It occurs most often due to malocclusion or malalignment or overgrowth of the teeth which grow continuously through the guinea pig's life. These need to be monitored and trimmed or floated (filed) as needed as it can lead to pain in the mouth, abscesses, anorexia and weight loss.

Guinea pigs are great little pets-Tiki was a prime example. We know her humans will miss her a lot, but are comforted in knowing she was a very fortunate little girl, loved and cared for and never knowing a moment of fear or pain or hunger. That is saying a lot in what can be a big scary world. Our sympathies go to her family, animal and human.

Peace,
DrReneigh