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Monday, January 26, 2015

Gooey Guinea Pig Abscess

Guinea pigs are generally sweet, low maintenance pets.  They don't need vaccines and their nutritional requirements are pretty simple to meet.  When they do get sick it tends to be from a rather small list of common ailments (and a large list of uncommon ones).  One of the more frequent problems I see in small rodents is abscesses.

**WARNING**  Some graphic images to follow.  You've been warned. 

This patient was an otherwise healthy female guinea pig who developed a swelling on the right side of her lower jaw.  It didn't take long to confirm this as an abscess, and we scheduled to have it drained.  In almost every case this requires some degree of surgery to fix and antibiotics alone won't resolve the issue.  The material within the abscess is thick and doesn't drain easily.  Sometimes it's as thick as toothpaste, or nearly so.  So we have to sedate them, open it up, and thoroughly flush and evacuate the pocket.

Here are some pictures after she was sedated and I was preparing her for the procedure.  You can see how large this was on her jaw.

And here's what it looked like when I opened the abscess and started squeezing out the material.  It had a consistency not unlike runny cottage cheese.

I expressed the pus and flushed the pocket with a disinfectant liquid until there was nothing coming out.  Here's what she looked like when I was finished.  By comparing to the pictures above you can see that the size is significantly diminished.  I left the incision open to allow further draining and sent her home with oral antibiotics. 

About 30-50% of the time we have to repeat the procedure or decide to surgically remove the tissue forming the pocket, as it can reoccur.  In her case the location on the jaw prevents us from being able to completely remove it without having significant issues closing the site.

She recovered well and went home.  Now we just have to keep our fingers crossed that it doesn't come back.

Friday, January 23, 2015

More Tartar Than Teeth

Pretty much every day we do dental cleanings on dogs and cats.  Sometimes it's very mild with hardly any appreciable tartar or calculus.  Other times we end up with severe periodontal disease numerous loose teeth, sometimes resulting in half or more of the teeth falling out or having to be pulled.  Many of these cases are pretty disgusting, but we're used to them.  But some of them impress even us rather jaded veterinarians.

One such case came in recently.  The dog was a pug that we've been seeing for many years, and was literally a few days away from his 17th birthday.  No, that's not a typo!  A pug that had actually lived 17 years, and though he had some age-related health problems was still going fairly strong!  It's rare to see any dog make it to 17, especially pugs.

It was no surprise that this guy had pretty bad teeth.  Due to his age the owner hadn't scheduled a dental cleaning in many years, resulting in some pretty severe dental disease.  He was missing numerous teeth due to being pulled or having fallen out due to gum and tooth infection.  The remaining teeth were obscured by the very impressive amounts of dental calculus present.  Here are some photos, though they don't really do justice to the extend of the problem.

On several teeth I literally could not see the tooth under the layer of calculus and tartar.  A few teeth had at least 1/4" (about 0.6cm) of thick calculus covering them!  I would not be surprised if a few of the teeth remained in place only because the tartar and calculus acted as a sort of cement, holding them together when they otherwise would have fallen out.

I felt really bad for the little guy, as I'm sure his mouth was very uncomfortable.  Part of me can't completely blame the owner for not risking anesthesia, even though I'm a big believer in "age is not a disease" and have done cleanings safely on dogs and cats older than him.  And there isn't a darn thing that will fix that much dental disease other than a thorough cleaning and likely extractions.

I think that the big lesson here is the need for preventative dental care.  We need to be doing at least annual cleanings on dogs starting at a young age to keep this severe of a problem from happening.  It is also important to do regular at-home dental care with appropriate brushing and/or chew treats.

As disgusting as mouths like this are, I'm certainly glad that I'm not a human dentist, having to see such problems in people!

Tuesday, January 20, 2015

"It'll Only Take A Sec!"

Let me describe a recent Saturday.  Normally we're open from 9am until 7pm, and the day was completely booked.  Every single appointment was filled, we had a full compliment of surgeries and dental cleanings, and including drop-off patients we had booked around 20-something pets for each of the two doctors working (myself and an associate).  One of our most experienced techs called in sick (something I've never seen her do so I knew it was serious) and we couldn't get ahold of anyone else to cover for her.  So we were extremely busy as well as very short-handed, missing a fourth of our normal support staff.  I was monitoring for several of the dental cleanings, running lab tests, reading fecal tests, all things normally done by a tech.  I was also seeing rooms without an assistant because everyone was busy with other patients.  
We were running a little behind and felt the rather hectic pace of the day, but were managing to get through.  It wass taking us a little longer than normal to get to some patients because of the short staff, but clients were being understanding.  We've had busy days like this in the past, and by pulling together and sharing the workload we make it through.
Then around 3:30 a client came in wanting to be seen.  He didn't have an appointment and wanted some bumps and scabs on his dog's back looked at. This was a regular client whom we have seen for years, so we did plan on seeing him.  But at that time we still had a dental cleaning we hadn't finished, were still down a tech, had absolutely no appointments available, still had drop-off pets that hadn't been seen....needless to say we were swamped.  My associate and I had not even had time to stop and eat something for lunch!!!  So I had the receptionist tell him that we couldn't see him in a room, but we'd be happy to have him drop off and we'd get to the dog later that afternoon.  That sounds reasonable, right?  We're still working him in and not putting the pet off until later in the week, right?

He threw a fit. 

"I just need the doctor to take a quick look." 
"Sorry, sir, the doctors are both busy, and we don't have any appointments available."
"Can't a nurse look at him and tell me what it is?  It'll only take a sec!"

He refused to drop his pet off and insisted on being seen by someone right away.  We explained that we simply didn't have the time or ability to drop everything at that moment, which wasn't sufficient for him.  He was genuinely angry and causing a fuss, and planned on making a formal complaint to the practice owner.

I just don't understand people like that.  The dog had what sounded like a minor skin problem and not an emergency (we had already accepted one emergency for the day and had seen it right away).  What doctor's office can you walk into without an appointment and expect the staff to put you ahead of everyone else who did schedule appropriately?  How does anyone consider such behavior reasonable?  And we weren't even making him wait a few days.  Even if I walk into an Urgent Care physican's office or an Emergency Room, I'm planning on having to wait for a long time, longer if more serious cases come in that trump my own illness.  Those types of doctors don't take appointments, so it's a first-come-first-served basis, other than serious cases that a triage bumps to the top of the list.  I don't know any human doctors that will put a walk-in ahead of the long list of appointments that people may have scheduled weeks in advance.  How is that fair to the people who took the time to schedule their visit?  Most people are very understanding for emergencies, but not for a few skin bumps.

"It'll only take a sec...." 

I hear that on a regular basis, and I don't think clients think through the process.  Nothing "only takes a sec".  While my techs are experienced and smart, they're not doctors.  They can't legally diagnose anything, and may not catch everything a doctor would.  A skin problem may not be isolated to one area and may be an indication of a larger issue, a situation I see every week.  Evaluating the patient properly means checking them in and taking the time to do a full, thorough exam by the doctor.  Depending on the condition we may want to run diagnostic tests, and then we'll have to work up a treatment plan.  All of that can take 20-30 minutes on the short end, and possibly longer.  It defintiely doesn't take "a sec".  A "quick look" is poor quality medicine and could easily overlook the real cause of the problem.

The client eventually left, still fuming, still refusing to drop off and still insisting on being seen.  But he did make an appointment for the following day to have a proper exam.  And then his wife called the day of the appointment and rescheduled for the following day.  Guess it must not have been so serious after all.  Definitely not worth having a fit.

To all pet owners reading this....if you walk into a vet's office without an appointment and want your pet seen, please be very understanding about their schedule and appointments, and realize that if you get put to the front of the line then someone else is getting pushed back.  If you had an appointment scheduled would YOU want to have to wait for a walk-in to be seen ahead of you?  We're not typically going to do that unless it's a true emergency.  Is your pet's case a "drop everything" kind of problem?  If not, don't expect us to do so.

And as I've said before, if you're going into the veterinary field because you don't like dealing with people, you are in for a very rude awakening.

Sunday, January 18, 2015

Nutrition Week #4: Feeding The Right Amounts

Over the last week I've been talking about various myths and misconceptions people have surrounding pet foods.  All of that is important, but there is also something that is just as important as the kind of ingredients....the amount of food given. 
Almost daily I'll have a client ask "how much food should I give?"  The answer is "it depends".  Just like there is no single food that is "best" for every dog or cat, there is no single amount that is appropriate across all situations.  There are a lot of factors that go into determining the right amount, such as age, activity level, health status, metabolic disorders, caloric density of the food, and so on.  Nutritional specialists and some general practice veterinarians will calculate the daily caloric requirement for the pet and then calculate how many calories the food has.  Honestly, that's too much math for me personally, so I try to make it simpler for myself and my clients. 
A good starting point is the chart on the side of the bag of food.  On just about every food you'll see a chart where you can look at the pet's weight and see about how many cups per day to feed.  However, there are several things to keep in mind about that information.  First, it's an average.  Each dog has a slightly different metabolism, so the recorded amount may be too much for dogs with a slower metabolism.  Second, they are generally made in the research facilities with animals that are not spayed or neutered.  Having a dog or cat "fixed" lowers their metabolic rate by about 30%, which has given rise to the myth that spaying or neutering "makes pets fat".  No, it doesn't, but it does slow metabolism so you have to be more careful with feeding habits.  Third, the charts are made based on dogs of average activity.  If your dog is extremely active or leads a sedentary life, they may need a higher or lower amount of food. 
But even given those factors, the chart is a good place to start.  If your pet maintains their weight, great!  Keep it up.  If your pet gains weight, you'll want to reduce the amount fed, possibly lower than the chart.  I feed my own dogs about a cup less than the low end of the feeding chart, in large part because they spend most of their time inside the house on the bed or couch, and really aren't burning calories.  I'm able to keep them at a lean, muscled body condition in this way.  If my dogs were much more active I'd have to feed them more than I do now, and possibly more than the recommended amount.
So step number one in proper feeding is to measure the food.  DO NOT just dump some in a bowl!  Get an inexpensive measuring cup or scoop, and put a specific amount in the bowl.  You'll want to know exactly how much your pet is getting, down to the fraction of a cup.  This is important for a couple of reasons.  If you're not feeding the right amount, you'll know exactly how much you need to increase or decrease.  You'll also be able to more easily monitor when your pet may not be eating quite as much, possibly alerting you to the early stages of an illness.
Now I know that there are some people out there who just leave food out for their dog or cat.  I don't have an issue with doing so IF (1) that is the only pet in the household, (2) you are still measuring out the food each day, and (3) your pet is maintaining a healthy weight.  So if your dog eats 3 cups of food per day and you put that amount in the bowl in the morning for your dog to graze during the day, that's fine by me.  We just don't want to exceed the recommended amount by filling the bowl as soon as it's emptied.
"But Dr. Bern, he seems so hungry when he's finished.  That means he needs more!"  No, that may not mean that he needs another scoop of food.  Many animals, like many people, simply enjoy the taste of their food.  How many times have each and every one of us continued to eat even when we're full, simply because it tasted so good?  Many people in Western societies are overweight or obese because they don't understand the concept of portion control and continue to eat poor quality foods because it tastes so good.  And I'll be the first to admit that I have that problem!  I often have to make a decision to turn down desert that I want because I know that I'm not really hungry by that point.  Most dogs and cats are the same way, but they have no self control.
Step number two of proper feeding is important in households with multiple pets.  You must separate pets when feeding them!  If you have three dogs and all of them are eating from the same bowl, how can you know how much each is getting?  You simply can't know.  If you have several cats and keep the food bowl full at all times, how much is each cat eating?  Are you surprised that at least one of them is overweight?  "But Dr. Bern, I put the bowls down in different places but as soon as Fluffy finsihes her food she goes over and pushes Butch out of the way."  I'm not surprised by these situations and it's normal for dogs and cats.  The solution?  Put each pet behind closed doors!
Let me give you an example from my own house.  We have three cats and two dogs.  One of the dogs and two of the cats are very motivated by food and will finish theirs quickly before seeking out other food.  In the past I would try to feed them in separate bowls but the same room.  Inevitably we'd have to shoo someone away from a bowl that wasn't theirs.  One of our cats is very docile and easily bullied by the others, and we started seeing him lose weight because he ate slower and would be pushed way from the bowl by a housemate.  When it's feeding time at our house we put one dog in the family room, on in their kennel in the laundry room, one cat in the upstairs bathroom, one cat in my son's bedroom, and one cat in the laundry room.  All doors are closed so nobody has access to anything but their own food.  Once everyone has finished eating we open the doors and let them mingle again.  That may seem like a lot of work, but the pets are trained to this method and will run to their respective places in anticipation of the meal.  Our kids feed the pets and it takes a total of less than five minutes to do all five pets in separate locations.  And all five of these pets are at a healthy, lean body weight. 
Ask yourself this....are you willing to invest five minutes per day to help keep your pet healthy?  Then you must separate pets to properly feed them.
Step number three....restrict the treats!  Most people don't realize how quickly treats and snacks add up the calories.  This is especially likely to happen in a household with multiple people.  "Oh, I only give a couple of treats per day."  Really?  Are you sure about that?  Take a week and write down how many treats you're actually giving.  Then write down how many each family member is also giving.  You may truthfully be only giving 2-3 treats per day.  But if your spouse and two children are also "only" giving 2-3 treats per day, then suddenly your pet is getting 8-12 treats!  Those calories accumulate quickly in cats and small dogs.
I'm not saying to never give treats.  Your pets like them, we like giving them, and it helps us bond with our pets.  But do so in a smart way.  Here are a couple of simple things you can do to help manage treats.
Start out by getting a small resealable kitchen container (Tupperware or other brands).  At the beginning of the day put a set amount of treats in that container (probably no more than 3-4, depending on the size of the treat and the size of the pet).  Whenever anyone in the family wants to give the dog or cat a treat, it must come out of that container.  When it's empty, no more treats can be given!  You're done for the day!  This method allows you to mange the snack output in the whole family without having to interrogate or hassle each member.
If you're still struggling with weight issues, use a portion of the food rather than separate treats.  If your dog should get 1 cup daily, measure that out in the morning and put some of the kibble in a container.  Those are the treats for the day!  By adding this modification you're able to give treats throughout the day and yet still not go over the daily calorie limit.
Step number four....exercise!  Like their human owners, animals need exercise to maintain proper weight and muscle tone.  Most dogs and cats lead a pretty simple, sedentary life, such as my own.  The more exercise in which you and your pets engage, the more calories you can get away with eating.  Olympic swimmer Michael Phelps eats around 6,000-8,000 calories per day when training, far greater than the 2,500 or so that an average person should consume.  How can he get away with that?  By having an exercise regimen that burns about 1,000 calories per hour!  Some pets can be maintained at a proper weight simply with proper nutrition and portion control.  Others need to be exercised more every day.
Other than in cases of metabolic disorders, pet obesity is a completely preventable and treatable condition.  Humans have pretty much 100% control of their pets' food, so if a pet becomes overweight, the blame can be laid at the feet of their owner.  Now, that may sound harsh and I'm not trying to beat anyone up.  In fact, I think that philosophy is encouraging, because it also means that owners have 100% control over the improvement in their pets' weight! 
Because this is a complicated issue, if anyone has pets with weight problems I strongly encourage you to talk at length to your own vet.

Friday, January 16, 2015

Nutrition Week, #3: By-Products, Limited Ingredients, Lamb

Our last bit on nutrition topics for now......
Myth #7:  By-products are bad ingredients and  must be avoided
Some food companies will try to convince you that by-products are nothing but junk, undesireable leftovers that have no nutritional value and may include things such as hooves and horns.  This is blatantly false.  By-products are cleaned and processed organ meat that by law and definition must specifically exclude hair, horns, hooves, skin, feathers, and gastrointestinal contents.  Ingredients defined as by-products can include lungs, spleen, kidneys, liver, blood, stomach, intestines, and other organs.  While we may not typically eat these parts of animals, these other organs contain important nutrients, some of which are not found in muscle tissue.  By-products are included in pet foods because they are lower cost sources of good nutrients, not as "filler".
Myth #8:  Over-the-counter "restricted ingredient" diets are sufficient for food allergies
Food allergies are triggered by exposure to a protein and/or carbohydrate source to which a pet has a sensitivity.  The treatment in these cases is to eliminate exposure of these ingredients in a pet's diet.  Typical commercial diets may not include these components on a label or in the recipe, but that doesn't mean that the allergens are not present.  Several studies have shown trace ingredients in pet foods that were not listed on the label.  This is not a problem for an average dog or cat, but for one with confirmed food allergies it could be enough to trigger a reaction. Just because "chicken" isn't listed on the label doesn't mean that there can't be trace amounts in the diet.  This finding is why veterinary dermatologists always recommend more strictly controlled "prescription" diets when diagnosing and treating food sensitivities.
Myth #9:  Lamb and rice diets are better for a pet's skin
This myth derives from a misconception about food ingredients and allergies.  When a pet has a reaction to food you will typically see symptoms related to the skin: hair loss, itching, skin infections, etc.  The way to resolve the problem is to feed a diet that eliminates the allergens and replaces them with ingredients to which the pet has never been exposed.  Many years ago we would use diets that had lamb as the protein source and rice for carbohydrates, as dogs and cats rarely ate these ingredients.  Because the allergens were eliminated the pet's skin would improve, but this only happened because the pet was allergic to other foods and not due to inherent qualities of the ingredients.  Currently lamb and rice are common in pet foods and are no longer considered good "hypoallergenic" diets because many pets have been exposed to them.  These components are no better or worse for an average pet than any other protein or carbohydrate, and for most pets won't give any benefit compared to other ingredients.

Wednesday, January 14, 2015

Nutrition Week, #2: Raw Foods, Bones, Meat

Continuing our discussion on pet nutrition....
Myth #4:  Raw food diets are better than commercially prepared diets
Raw foods carry a significant risk for bacterial contamination.  Studies have sown that 20%-35% of raw poultry and 80% of raw food diets for dogs tested positive for Salmonella, while 30% of stool samples from dogs fed these diets were positive for Salmonella.  While a healthy dog may be able to cope with some dietary bacteria, others cannot.  There is also a significant human health risk of exposure to dangerous bacteria.  Numerous parasites can be found in raw food, presenting a risk to the health of the pet and their human families.  Raw diets have been consistently shown to contain imbalances in the Calcium:Phosphorous ratio, excessive Vitamin A and D, and other mineral imbalances.  There have been no controlled, scientific studies that have shown raw diets to be better for the health of pets than commercially prepared foods.  As with grain-free diets, any perceived benefits are likely due to a higher fat content and lower fiber content rather than the issue of raw versus processed foods.
(also see previous discussions here and here)
Myth #5:  Bones are good for dogs and cats
Studies of wild dogs and cats have shown no differences in the rate of dental disease compared to pets, even though wild carnivores chew on bones frequently.  Bones are very hard and are a frequent cause of fractured teeth, which can be very painful and require dental extractions.  Small or splintered bones cause a risk of obstructing or puncturing the esophagus, stomach, or intestines.
Myth #6:  Meat should be the first ingredient
The ingredients are listed on pet food bags by pre-cooked weight.  So the first ingredient weighs more than the second before they are processed, and so on.  Meats contain a high level of water, which is removed during cooking and processing.  Water is heavy, so the pre-cooked weight is not a good indication of the percentage of nutritents that actually come from that food.  "Chicken meal" as the third ingredient, may actually contain more protein than "Chicken" as the first ingredient because the meal has been ground and dehydrated, removing the water.  So ingredients on the list are placed lower merely because they weigh less, not because they carry fewer nutritents or contribute less to the diet.  If "chicken", "poultry meal", and "corn gluten meal" are all included on an ingredient list, there is no way to tell from the packaging which ingredient actually contributes more protein than another, since the ingredients are listed by weight and not by nutrient density.  A perception of the seeming benefit of "meat" may be the fact that this ingredient contains more fat that "meal", which as discussed above can result in a glossier coat but doesn't mean the nutrition is better.
(also see previous discussion here)

Sunday, January 11, 2015

Nutrition Week, #1: Corn, Wild Diets, Grain-Free

Pet nutrition is a bit of an interest for me, and while I'm not an expert by any stretch of the imagination, I've looked into a lot of the common issues and have spoken with many board-certified experts.  Much of what I've learned goes contrary to what you will see in some corners of the Internet or by talking to some food reps, but it is still accurate and true.  Over the years of blogging I've discussed some of these issues, but thought it might be fun and helpful to dedicating a week's worth of posts to clearing up some misconceptions.  Let's begin!
Myth #1:  Corn is a bad ingredient, has no nutritional value, and causes allergies
Ground corn and corn gluten meal are important nutrients, providing good energy and an excellent source of secondary protein.  In pet foods it is over 95% digestible and is not a "filler".  It is one of the lowest sources of food allergies, causing a problem in only around 1% of patients with a confirmed food allergy.  Corn gluten is also an important source of fatty acids such as linoleic acid, antioxidants, and several vitamins (B complex, E, and A).
(also see other discussions on this topic here and here)
 Myth #2:  Dogs need to be fed a diet that resembles their wild ancestors
Dogs are NOT wolves and their digestive tract has significant differences.  Over 10,000-15,000 years of domestication their diets have involved greater consumption of grains and their genetic makeup has changed to accommodate this change.  Modern dogs are different from wolves in several key genes that involve starch digestion and gulcose uptake.  There is no benefit found to feeding a dog the same diet that would be fed to a wolf.
(also see another post on this topic)
 Myth #3:  Dogs should be fed a grain-free diet
This myth is currently popular and is not based on any scientific evidence.  As with the above myth, dogs have gentically changed to be able to handle grains and other carbohydrates.  Unless an individual pet has a sensitivity or allergy to a specific type of carbohydrate, there is no proven health benefit of grain-free diets.  Any perceived benefits may be due to a higher fat content in grain-free diets, which can help improve coat quality, and a lower fiber content, which can reduce stool volume.  But these factors are independent of the grains themselves and can be achieved even with diets containing grains. 
(also see another post on this topic)