Haley is Weak and Wobbly

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

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Run Quik, Run!

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!

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

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

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

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!!!!!!!!

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