Biscuit's Bad Leg

Holly has this question about her dog...

I've taken my 10-year-old mixed breed, Biscuit, in to be seeing by the vet on a regular (well pet) schedule.  She is 10 years old, a border collie/ shepherd/??? mix.  She had issues with diarrhea as a young dog and has been on Eukanuba low residue diet her entire life since these problems emerged (18 - 24 mos.)  She is exhibiting pain in jumping up onto "her" chair, never jumps on the bed anymore and her right upper leg appears to be "wasted".   Nonetheless, she still enjoys a 3 mile walk each and every day without limping and is not overweight.  My vet took an x-ray of her hip and spine.  While the spine shows evidence of some arthritis, the hip appears unaffected.  What are we missing here?  I've changed her dog food to a completely organic brand (senior formula) but she continues to exhibit pain.  I've just started this regimen (only 1 1/2 weeks in) and have been giving her a supplement of DGP to help with the pain.  Should there be an x-ray of the entire leg, not just the hip, to check for bone cancer in the leg?

One of the things that stands out to me in this case is the "wasted" appearance of the leg, which I'm assuming is atrophy of the muscle.  When it happens bilaterally or in general muscle groups in multiple areas there can be a disorder of the muscle itself, as well as general causes of wasting such as kidney disease, cancer, and so on.  But when it happens very specifically in one limb, it is usually due to a lack of use of that limb.  When muscle is used it grows; when it is not used, it shrinks and deteriorates.  So if it's just her right thigh that's "wasted", it's probably an indication of a long-term lack of or decreased use of that leg even if you haven't seen a lot of limping.  Many dogs will ignore pain and discomfort when it's an activity that they really enjoy, such as walks and playing.  Pushing through the pain is one of the reasons we can see dogs that are otherwise uncomfortable be able to do some high-energy activities.

Most of the time when there is bone infection or cancer there will be a swelling of the bone that is visible or palpable.  In these cases you should certainly take further x-rays and likely a biopsy of the bone.  Without outward signs there may not be a strong indication to radiograph the rest of the leg.  And I think if it's this painful there would probably be more signs that you wouldn't need x-rays to see.  However, with a lack of other visible causes I think it certainly wouldn't hurt to check for subtle issues.

"Organic" or "inorganic" foods won't make a difference with joint pain.  Honestly, in my opinion, the "organic" food craze in humans and animals has very questionable health benefits compared to other foods.  But that's not the point of this discussion.  My point in Biscuit's case is that a switch from one maintinence food to another one, regardless of manufacturing or brand, will not have any significant outcome on pain or joint problems.  There is nothing about organic foods that will lower pain or aid joint function.

If this is related to arthritis (and such problems aren't always easily visible on x-rays), here is my typicall recommended approach.
1.  Have your pet at a normal weight.  In Biscuit's case this apparently isn't an issue.
2.  Use a food or supplement high in glucosamine and chondroitin.  Be aware that studies have shown some questionable results as to whether there is real benefit, though clinically most vets have seen cases that really are helped by it.  Not all supplements are created equal!  Just because the ingredients are in the formulation doesn't mean that they can be easily absorbed into the pet's system.
3.  Use good essential fatty acid supplements, especially omega-3.  There is strong evidence that these ingredients act as effective natural anti-inflammatories and can give benefit in arthritis and skin disorders.  However, you normally need very high levels.  Many people want to give a couple of fish oil capsules, and though this approach is in theory sound, in practice you can't get any benefit.  A 50 pound dog would need to take over 40 capsules per day to be strongly affected!  However, there are supplements and especially specific foods that have the necessary ammounts.  I have good personal experience with Royal Canin Mobility Support and Hill's J/D.
4.  An emerging supplement in arthritis is green-lipped mussel (a shellfish).  This is starting to show up in some foods and supplements and has some very promising results.  I know that Greenies recently starting making a treat with this as a main ingredient, but I don't have personal experience with it.
5. In bad cases, prescription pain medications should be used, though in an older dog you should have routine blood testing prior to starting on them.  Most non-steroidal anti-inflammatory drugs (NSAIDs) designed for dogs are safe and effective.  Talk to your vet about which one they normally use.
6.  Adquan is an injectible medication that has been shown to help rebuild joint surfaces, and can make a big difference in arthritis pain related to degenration of the joint.  This is another thing to talk to the vet about.

If these suggesitons don't help with Biscuit's pain, you may have to consider being referred to a speciality practice. They may want to do special studies on her spine and limbs to look for signs that you can't see on an x-ray.  You may need a myelogram (dye injected around the spinal cord) to see certain mild slipped discs between the vertebrae, or need MRIs or CT scans.  All of these things are expensive, but if the problem can't be controlled medically and nutritionally, may be the best way of finding the cause of the problem.

Good luck with Biscuit!

Christmas With The Berns

I've taken a few days off and let my associates handle the duties, a perk of being in charge.  Don't worry, they're getting time off also.  But I wanted to have a little extra time with my family.

Yesterday I spent the entire day in PJs, playing games and watching movies with my wife and kids.  It was really nice to have that kind of slow, relaxing quality time with my family.  With the way life can get hectic sometimes, it can be hard to have that kind of time.  We rarely slow down long enough to really see what is around us in our own lives, especially this time of year.  There is so much going on around Christmas with obligations, parties, shopping, and so on that we can forget what the season is really about.

Remember that this is supposed to be the Season of Giving, not the Season of Getting.  And about 2000 years ago we were given the best gift of all...the birth of the baby Jesus.  Without Him we wouldn't have Christmas and all that it means. We should all reflect on what that means.  We have the grace of God and an example of love beyond all understanding.  When we give presents it's a reflection of what God gave to us, and what we can still have.  The most holy, influential, and powerful man to walk on Earth, and he started out being born to working parents in a stable surrounded by animals.  We are supposed to love each other and show compassion because God showed love and compassion to us first.  Don't forget that.  Don't forget where this all began.

Today is more family time.  We're going to see Voyage of the Dawn Treader with the kids, then my son and I are going to see Tron: Legacy.  He and I will get that time together as guys, and my wife and daughter are going to have some time as girls. Then we're going to open our Christmas gifts to each other this evening (a Swedish tradition) after reading the Christmas story from the Bible.  Really, on the surface it's nothing spectacular, but it's amazing quality time with the family.  It's nice to slow down a little.

Wherever you are and however you celebrate the holiday, I wish you the best and merriest Christmas! May God bless you and your family!

Mysterious Bloody Urine

Meaghan presents this situation...

ok here is the background...

female american bulldog/french mastiff mix.  dob 9/2/2009.

i had gotten her, Chaise, when she was 8 weeks old.  she was from a litter of 13.  at around 3-4 months she started to have blood in her urine.  everything else was fine, eating sleeping, playing all fine.  took her to vet, said twice it was just a uti.  she was on antibiotics for 4 weeks and nothing helped clear it up.  switched vets and the new vets ran many more tests including; xrays, cultures, cbc, liver functions, kidney function, clotting test, ultrasound, and finally exploritive surgery which she also got spayed.  still nothing.  all the test came back fine. and the surgery all they could say was that there was some blood in her bladder but they could not determine from where.  they did take out a small piece of "extra" growth or something but tested it and it came back fine too.  this peeing blood went on for about 5 months.  then one day out of the blue it just stopped.  i was thinking the the surgery fixed it and it just took a while for her to heal.  i was wrong.  it started back up this november.  same as before, blood in the urine but not showing any other symptoms.  took her to the vet hoping it was a uti this time but after being on antibiotics for 3 weeks it hasnt' cleared up.  all the vet said this time was "hmm isn't this funny, maybe it's an allergy or something".  i don't know what to do.  i can't keep bringing her to the vet for the same tests as before (which ran me about $4000+) and the vet not even being able to give me any help or answers.  is there anything you can suggest?

This is an extremely unusual situation, and I'm sure you are very frustrated by a lack of answers.  However, I can't see that this is a problem with your vet based on what you've described.  My first thought would be a urinary infection, but obviously this has been ruled out.  The second possibility would be bladder stones, which should have been noticed on x-rays or during the bladder surgery; this would also be extremely unusual on such a young dog.  The next possibility would be a mass of some sort.  If it was in the bladder this would likely have been noticed during the surgery.  Honestly, all of the steps taken were appropriate.

There is one more thing I would consider at this point.  There would be a possibility that the bleeding is from the vagina and not the bladder.  Did your vet do a thorough vaginal exam?  This should be done under heavy sedation or light anesthesia, as it can be painful.  Without the proper speculum it might be a little more difficult, but can be done with an otoscope.  If the vet can't see all of the way to a cervix, it might be necessary to be referred to somewhere with an endoscope.  A vaginal mass would be rare, but could explain the lack of efficacy of the antibiotics and the inability to find it in the bladder.  Removing a vaginal mass would be difficult and may require a specialist, but could be curative.

If it's not in the vagina, I would strongly recommend referral to a multi-discipline specialty practice or a veterinary college.  There may be tests (such as a CT scan or urethrogram) that could identify the problem and aren't readily available in general practice.  At a clinic or college with several kinds of specialists they can work together to cover all possibilities.  Going to a specialist would likely cost another several hundreds or even thousands of dollars, but if your vet can't find the problem, it may be the only way to figure out what is going on.

MMMRREOOOOOWWW!!!!

I've been practicing for 13 years, so it takes a lot for a client to really surprise or startle me.  Today this happened.

The client came in because her cat had been in a fight last night and had a swollen leg.  Not necessarily a big deal, as I suspected an abscess or other injury.  When my tech came out of the room after the initial exam, he said that the client seemed a little bit strange and wasn't being reasonable.  For example, she refused to let us weigh the cat, saying he was "about 13 pounds" but not letting us confirm (I was able to weigh him later and he was 14.3 pounds).  I've seen some strange clients, so I didn't worry about it much at that point, figuring it would be just another odd interaction.  Little did I know....

So I went into the room, introduced myself, and said hello to the cat.  As I was first beginning my exam, I said "So I hear he was in a bit of a fight last nigh."  All of a sudden...MMRREEEOWWWWW!!!  A loud, extended, unexpected scream.  From the client!  I'm not kidding.  The cat was well behaved and quiet.  But the client let out with the loudest cat-scream I have ever heard, and it went on for several seconds.  I was truly and completely startled, and even a bit scared.  There was no warning or preface at all, just the sudden scream.  At first I honestly wondered if the client was having a sudden fit or even an episode of Tourette syndrome.  I just stood there startled, not really sure what to say or do, and almost asked her if she was okay.  I've never seen a human make such a loud, startling noise without any reason.

Then she said "and that's what it was like all night," meaning the cats.  Really?  You could have warned me ahead of time!  "All night this was all I heard..." and then make the sound.  Sure, it would still be strange, but there would have been some warning and context.  Wow.

And y'know what? She did the scream again later in the visit, though not quite so loud.  Why she felt the need to repeat it I'm not certain.

I really think this client wasn't the sharpest knife in the drawer (not being intentionally mean).  She said that another vet had diagnosed the cat with feline leukemia, probably acquired from getting into fights.  This surprised me since he was an outside cat.  So I pointed out that by keeping him outside she was allowing him to infect other cats when he fought.  She said "Oh, I've never thought about it that way."  Really?  He became infected through fight wounds yet it didn't occur to her that he could infect others through fight wounds?

In the end we treated the cat for infection and fever and I think he'll do okay as long as the leukemia doesn't activate.  But this was truly one of the strangest client experiences I've ever had.

Using Drugs With Imagination

Acepromazine is a common drug in veterinary medicine, used primarily as a sedative.  It comes in both pill and injectable forms and is something we use in one form or another on a daily basis.  It's also been around for a long time, so it's something we're all very familiar with.  Yet one of my techs showed me something quite surprising.

On the bottle of acepromazine there was a drug guide, something common to all medications.  These guides discuss the pharmacology of the medication, including structure, common uses, dosages, adverse effects, and so on.  Much to my surprise, this is what is printed on part of that label.

"Description:  Acepromazine maleate USP, a potent neuroleptic agent with a low order of toxicity, is of particular value in the tranquilization of dogs, cats and horses.  Its rapid action and lack of hypnotic effect are added advantages.  According to Baker, the scope of possible applications for this compound in veterinary practice is only limited by the imagination of the practitioner."

Yes, that's a direct quote from the official label on the bottle, though the emphasis is mine.  When I first read this I honestly couldn't believe it.  I don't remember being taught how to use medications with imagination.  Usually we have specific directions and indications of how to use each drug.  But apparently with acepromazine we are free to let our imagination soar!  Here are a few quick things I thought of....
*  Put some on a person's seat to make them think it's urine (the solution is a deep yellow color).
*  Write my name in the snow with a syringe of ace (same reason as above).
*  Mix it with chlorhexidine (a blue disinfectant) to make pretty colors.
*  Take a bottle of it and attach a fish tank pump to make a nice fountain.
*  Use it in a magic potion to summon a faerie (hey, my imagination isn't limited by quirky things like so-called "reality").

Since we're now using at least some medications based on our imagination rather than specific guidelines, what imaginative things can any of you come up with for any drug in our formulary?

Costs Of Dog Ownership

I received a great question from a reader, Jessica....

I'm going through the very intensive decision over whether I will adopt a dog next year. I am an extremely responsible, pet-experienced twenty year old, and I have two years experience in the doggy daycare industry and I know I'll have no problems properly caring for a dog. Similarly, I've also realized that I can work my schedule out so I'm home most of the day with the dog.

 

My only concern is the cost of vet bills. I have a good chunk of money saved up in case of emergencies (which I would use if necessary) but I do wonder what the yearly physical, with shots and such, tends to cost.

 

I know that perhaps one of the biggest problems people have when they own animals is being able to pay for them financially and I want to make sure I have all my bases covered before deciding and looking this coming summer.

 

Jessica, I have to say that I wish more people were like you!  I can't say that I've ever had anyone ask me this (surprisingly enough) and I'm happy to answer it.  If more people would look into this BEFORE getting a pet, there would be healthier pets as the ones around would be better cared for.  

 

So let's do some math...As a disclaimer, I just want everyone to know that these figures are in US dollars and are based on my personal knowledge and experiences.  Check prices yourself and don't use these as direct quotes.

*  Office visits--These generally range from $30-60 and you should plan on 2-3 visits per year (combination of well and sick).  Annual Total:  $60-180

*  Vaccines--The current consensus in the veterinary field is that the distemper-parvo combination and rabies vaccines are the "core" or non-negotiable ones.  Other vaccines have some degree of debate, but I personally feel that leptospirosis is important, and any dog getting groomed or boarded should receive the kennel cough (bordetella) vaccine.  Most vaccines will range from $15-30 each.  Annual Total:  $45-105

* Heartworm testing--This should be performed annually and will run around $30-40.

* Fecal testing--This should be done 1-2 times per year to screen for intestinal parasites and will run around $30 each time.  Annual Total: $30-60

* Heartworm prevention--This should be given monthly in a tablet or twice yearly with a Proheart6 injection.  Depending on the size of your dog, six months of prevention will run $30-80.  Annual Total:  $60-160

* Flea prevention--Again, this will depend on the size of your pet.  It also depends on where you live, as in some locations you'll need flea prevention year-round.  When it comes to flea medication you don't want to use the cheap kinds as they don't work very well.  For a four-month supply this can run $40-60.  Annual Total:  $120-180

* Food--This one is hard to estimate because of the high variability in costs of food and amounts fed by food type.  With my own pets I spend about $40 every 6-8 weeks for two dogs.  So let's say $20 per month per dog as a rough estimate.  Annual Total: $240

Okay, so now pull out the calculator...carry the one...and we have a total annual cost for comprehensive basic preventative care of....$585-965

Obviously there are a ton of variables in these calculations, as prices will vary by region, how big your dog is, and what kinds of preventative care you get.  Now the good news is that these costs are spread out over the year, so you don't have to come up with it all at once.  However, this doesn't include any illnesses or emergency situations.  In addition to the basic costs of care and maintenance, I recommend having an emergency fund of at least $500 that you don't touch for any reasons other than medical problems with your dog.

Jessica, hopefully this gives you a basic idea of what pet ownership will cost.  If you don't think this will be possible, then please don't get a dog until you're ready. If these costs are within your budget, then Have a great time!

Evolving Anesthesia

Currently my practice is getting ready to change our anesthesia protocols.  We've spent time reviewing the literature, consulting with specialists, and deciding what is both safe and cost-effective to use.  I'm pretty excited about the changes, and really believe that it will allow us to have better and safer anesthesia, as well as better and safer pain control.

Most clients probably don't realize that the anesthesia can be extremely different from one veterinary practice to another.  There simply is no one, single consensus among veterinarians regarding which protocol should be used.  Some vets elect to do anesthesia as cheaply as possible to make it available to more people, recognizing that the cheapest drugs usually come with greater risks than others.  Some vets use the most modern equipment and drugs, realizing that their anesthesia will be more expensive than their colleagues, but willing to do so for the increased safety.  There are numerous variables to how anesthesia is performed, including drugs used (inhaled versus strictly injectable, and then several choices in each category), supportive care given (warming aids to reduce hypothermia, fluid support), monitoring (ranges from none at all to ECGs, blood pressure, and oxygen monitors), and analgesia (ranging from none at all to both pre- and post-operative pain medications).

I have seen many changes in my 13+ years of practice and 26 years in the field.  Many of those changes have been in the last 5 years as research expands and companies develop better drugs.  The way we as a profession look at anesthesia and pain control in 2010 is a far cry from how we looked at it in 1990.  And depending on how they have kept up with their continuing education, a veterinarian who has been practicing for 30 years is likely going to see the subject differently than someone who just graduated. 

What does this mean for a client?  Ask LOTS of questions about how your pet is being treated and monitored.  When you ask about surgery costs and ask "what does that include?", don't settle for an answer of "Oh, it covers everything."  Yes, I've heard veterinary practices state it that way.  Ask details of precisely what is included, which drugs are used, and how monitoring and supportive care is done.  If you're comparing veterinary clinics, please don't go simply on price, as there are inevitably shortcuts made or corners cut in the cheaper of two quotes. 

What does this mean for a veterinarian?  We all need to keep up with current research and options, striving to do the highest quality and safest care possible.  I can guarantee that how you were/are trained in school is not going to be the standard in a decade or two.  Change in medicine is continual, usually for the better, and it's our responsibility to keep up with the new knowledge.

In essence, anesthesia is willfully bringing a pet closer to the conditions of death than we do in any other circumstance.  It's important to make it safe and reversible with no long-term consequences.  There is no way to make this perfect in 100% of the cases, but we can continue to improve.  Embracing the change is a good way to do so.

Exotics Week: Practice Builder

Today's entry is specifically directed at veterinarians and veterinary students.  But the rest of you can get some insight into running a veterinary practice.

I know that as veterinarians we don't get much practice in exotic pet medicine in school, and some vets simply don't like seeing these pets for personal reasons (such as s snake phobia).  However, I've known many vets who don't see exotics because they feel they don't have the right training for it and are unwilling to take the steps to get the training.  Those vets are missing out on a potential practice builder.

I'm one of the few vets in my area who will see just about anything you can bring in (other than livestock and large animals).  I don't consider myself an expert, but I can certainly see many kinds of animals with skill.  Because of the variety of animals I'll see, I've had many clients drive long distances and pass other vets in order to come to my practice.  Sometimes this don't go far, depending on the health of the pet.  But other times it leads to far bigger things.

Many people with hamsters, reptiles, and other exotics also have dogs and cats.  And most people don't like driving to different vets for different pets.  More than once I've had a client bring in a hamster or other small pet, get to know and like me, and then start bringing their dogs and cats to me.  It's not that I'm better than their previous vet...I'm just willing to see ALL of their pets, not just some of them.  Wherever I've lived I've been able to develop this kind of reputation, and it's helped grow my practice.

I would encourage anyone going into small animal medicine to develop at least some basic skills with exotics.  You may not get much experience in vet school, but all major continuing education events have seminars on exotics medicine.  There are also several organizations and journals available that can give training in basic skills.  Most of my knowledge is self-taught, going to these meetings and reading all available resources.  Then it's a matter of just jumping in and doing your best.  Very quickly you'll develop the skills you need to see these little critters.  Not only will you be able to provide care to pets that might otherwise not get any, but you'll also see your practice grow a bit.  It's a win-win for everyone!

Exotics Week: Overgrown Teeth

All rodents and rabbits (technically rabbits are lagomorphs, not rodents) have teeth with open roots that grow throughout their lives.  By chewing on hard objects they naturally wear the teeth down so they don't become too long.  However, sometimes the teeth do become overgrown and this can cause serious problems.

Most people don't look at their pet's teeth, so early signs usually go unnoticed.  It's also impossible to see their molars by simply looking at their mouth, so normally the incisors are the only ones visible.  Therefore problems with the incisors can be noticed by an owner, but not problems with the molars.  So what do you look for?  Really, there are two main signs.  The first is not eating.  Overgrown teeth can rub against the tongue or the inside of the cheeks and cause painful sores.  They can also make normal movement of the mouth difficult, preventing eating.  The other symptom is hypersalivation, commonly called "slobbers".  If either of these are happening, overgrown teeth can be the cause.

Here are some rather dramatic pictures of overgrown incisors in rabbits.

As I mentioned, molars are much harder to see, and usually take special instruments or sedation.  Here are a few pictures in guinea pigs.

If your veterinarian diagnoses your pet with overgrown teeth, they will need to be trimmed.  However, this needs to be done by a vet who knows how to do it and ideally has the proper equipment.  Do NOT let a vet trim your pet's teeth with nail trimmers!  Some vets are in the habit of doing so (and I did this before I learned better), but it is actually dangerous to do.  Nail trimmers can cause the tooth to split along its length, causing even worse problems.  It's also common that once teeth start to overgrow they will periodically need to be trimmed for the rest of the pet's life.  But not doing so can lead to your pet's death.

Exotics Week: Blood Feathers

Anyone who has birds should know about blood feathers.  This isn't a disorder and is a natural part of the feather growth.  However, broken blood feathers can be a big mess.

When a new feather starts to grow in, it has blood in the shaft to give nutrients during the growth phase.  The blood gives the shaft a dark blue appearance and is very distinctive.  Here are a couple of pictures.

Once the feather reaches full growth, the blood recedes, leaving the shaft hollow and clear.

Problems can happen when the blood feather breaks.  This can occur when the wing or tail beats against the side of a cage or other hard object, during rough handling, or during a wing trim.  Since the shaft is filled with blood and has a connection to the rest of the circulatory system, there can be a lot of bleeding.  Luckily, there is rarely any life-threatening blood loss.  However, this can be very messy and certainly cause the bird owner a lot of concern.  So if this happens there are a few things you can do at home.

1.  Wait.  Many times the bleeding is minimal and will stop on its own.
2.  Apply flour or cornstarch with some direct pressure at the break.  This isn't quite as good as styptic powder, but virtually everyone has one of these ingredients in their cabinets, so it's something that can be used in a pinch.
3.  If the bleeding won't stop, you can pull the feather out yourself.  This isn't easy for many people, and usually involves one person holding the bird while the other plucks the feather.  At home the best tool is needle-nosed pliers, but a pair of hemostats is easier and what I use in the clinic.  Grab the broken feather at the base and pull hard with a solid, steady yank.  The idea is to pull the feather out on a single pull, rather than drawing it out slowly.  Usually removing the feather stops the bleeding.  If any bleeding remains, do step #2 on the area where the feather used to be.

Exotics Week: Guinea Pig Mites

I see a lot of guinea pigs in my practice and the single most common problem I see in them is skin mites.  Now first I want to clarify that mites and lice are very different.  Mites are microscopic and lice are barely visible.  Though they may have some similarities in causing itching, their behavior and progression are different.

A guinea pig with skin mites is invariably itchy. Sometimes mildly so, but often very significantly so.  In fact, a guinea pig can itch so severely that they will go into full-blown seizures.  This may happen spontaneously or after handling or scratching.  Though the seizures are scary to see, they aren't harmful and will go away once the pet is treated.

These pets will start to have scaly, scabbed skin and will lose hair.  As the disease progresses the skin symptoms will worsen, sometimes to the point of a virtually hairless guinea pig.  Much of the skin may be injured from the pet scratching themselves so deeply because of the itching.

In the early stages it may be difficult to tell whether a guinea pig has skin mites or ringworm (a common skin fungus).  Two tests are normally needed.  The first is a skin scraping where we try to find the mites under the microscope.  However, this is not always fully diagnostic, as the mites may be present but in few enough numbers that they're not easy to find.  A good rule-of-thumb that I use is that if the pet is significantly itchy or is having seizures, it's almost assuredly mites since ringworm doesn't cause severe itching.  If there is any doubt, a fungal culture of some hair samples is needed.  Don't let a vet use a "Wood's lamp" or ultraviolet light on these pets in screening for ringworm.  The principle is that certain species of ringworm will fluoresce an apple-green color under ultraviolet light.  But guinea pigs and other small pets aren't infected by these species, only by species that won't fluoresce.  So though this is a common diagnostic tool in dogs and cats, it's worthless in guinea pigs.

Once a diagnosis is made or significantly suspected, treatment is pretty easy and effective.  Most commonly they will receive injections of ivermectin, a common antiparasitic.  In most cases a series of two injections spaced 10-14 days apart will resolve the problem, though occasionally a third or even fourth injection might be needed.  I've never seen a case that needs more injections that this, so if it's not going away after four injections I'd re-evaluate the case.  I also recommend thoroughly cleaning the cage and replacing all of the bedding twice weekly until the problem is resolved.

All-in-all this is a very rewarding condition to treat, as they almost always get better.

Exotics Week: Metabolic Bone Disease

Continuing with reptiles, let's take a look at another completely preventable condition in captive reptiles...metabolic bone disease.  This disorder involves a lack of proper bone absorption of calcium, resulting in a serious health condition. Though it's primarily seen as a problem in the bones, calcium is also involved in proper muscle contraction so you can see muscle problems as well.

Proper calcium metabolism requires two parts.  First is taking in enough calcium.  Reptiles must be fed specific calcium-rich fruits and vegetables, especially dark green leafy vegetables (kale, spinach, mustard greens, collard greens, etc.).  It's sometimes surprising how many people don't realize that many pet reptiles are mostly herbivores and don't need much in the way of insects as meals.  When those insects are fed, or if the reptile is mostly a carnivore, the prey should be properly prepared.  This can be done by "gut loading", or feeding the prey a nutritionally rich food.  The idea is that when the reptile eats its prey it also ingests the nutrition in that meal's digestive tract.  The other way to properly prepare food is to "dust" it with a calcium powder that can be purchased in any pet store that sells reptile supplies.  No matter how it is accomplished, there must be plenty of calcium in the diet.

However, you could feed nothing but calcium and still have a problem if there isn't proper lighting.  In order for calcium to make it into tissues and bones the body needs vitamin D3.  If there is a deficiency of this vitamin then all the calcium in the world won't do much good.  The body naturally produces this vitamin when stimulated by ultraviolet light.  This is the main reason why you need a full spectrum UV light in any reptile enclosure.  The package of the bulb will state if this is the case, and you should look for statements like "full spectrum UV" or "UVA and UVB".

There are other factors in metabolic bone disease, including kidney and liver disease, too much phosphorous in the diet, or environmental factors that may impair calcium absorption.  But in my experience the biggest reasons for this disorder are diet and lighting.

This is a gradual onset that may not be obvious in the early stages.  But by the final stages these are very sick reptiles and can die if not treated quickly.  Here is a list of the most common symptoms:

• bowed or swollen legs, or bumps on the long bones of the legs
• arched spine or bumps along bones of spine
• softening and swelling of the jaw, sometimes called "rubber jaw"
• tremors or jerky movements
• lameness
• lack of appetite
• constipation
• fractures of the bones due to bone weakness
• lethargy, weakness and even partial paralysis (sometimes unable to lift body off ground)

Treatment usually involves changing the causative factors, improving diet, housing, and lighting.  With seriously ill reptiles they may also need vitamin injections or supplements.  With aggressive supportive care there is a chance of saving them.

Remember yesterday how I said that many common health problems can be prevented with proper care?  Don't forget that.  Like vitamin A deficiency, metabolic bone disease is completely preventable and should rarely happen with properly cared-for reptiles.

Exotics Week: Vitamin A Deficiency

I haven't done a themed week in a while, so it's about time.  Exotic pets are a strong interest of mine to the point where I'm designated as training people in this area in my practice.  I thought I would share some important topics that might help owners of these pets.

The first topic is vitamin A deficiency, mainly seen in turtles.  This is a completely preventable disease, as it's related to improper feeding.  The patient most commonly presents with swollen, puffy eyes and potentially torn or raw skin.  It's also common to have some nasal discharge.  Though lab tests can help establish the pet's health, this is mostly a diagnosis based on exam and clinical history.

Once the diagnosis is made, treatment is pretty simple.  Improve nutrition!  For carnivorous turtles I commonly recommend feeding a piece of liver once weekly.  However, there are some other foods, especially for herbivorous animals.  Here's a list of foods high in vitamin A:
Apricots
Broccoli leaves and flowerets
Cantaloupe
Carrots
Collard greens
Dandelion greens (beware of lawn treatments)
Kale
Mango
Mustard greens
Nectarines
Papaya
Parsley
Peaches
Sweet potatoes
Spinach
Turnip greens
Yellow squash
Liver
Whole fish

However, there is a danger in feeding supplements.  Vitamin A can actually reach toxic levels, so you don't want to feed these vitamin-rich foods exclusively.  Make sure to include them in the normal diet but don't go overboard.

Vitamin A deficiency is a perfect example of one of the main points of exotic pet care.  A large majority of the health problems we see are due to inappropriate husbandry, housing, and diet.  If you have these things well under control you'll be a long way to keeping your pet healthy.

Why So Many Women?

There was a recent article describing why women choose certain professions, especially in medicine.  The study described that one of the biggest determining factors was not an inherent love of the field, but its low cost to families.  The professions that allowed the best balance of work and family are the ones that women are choosing to go into.  And yes, veterinary medicine is one of those fields.  Here's a quote from the article.

Among professions with the fastest-growing proportions of women are veterinary medicine. Because of growth in veterinary hospitals and emergency clinics, vets increasingly have been able to eliminate on-call, night and weekend hours, and to work part-time, Goldin says. The proportion of female grads in vet medicine has soared to almost 80%, from 10% in 1970. In other examples, pharmacy grads are now 60% female, up from 30% in the mid-1970s, Goldin says. And optometry is about 60% female.

The article mentions a second discussion (linked above) that gives the following quote.


Drawing from data on Harvard graduates and on University of Chicago MBA grads, Goldin contrasted MBAs to veterinarians. Fifteen years after college, among those women who have kids, 23% of MBAs weren’t working, versus 3% of MDs and 14% of lawyers. “The MBA lure for women is large; incomes are substantial even though they are lower than those of their male peers. But some women with children find the inflexibility of work insurmountable and leave or become self employed,” she said.
“If women are ‘fleeing’ the corporate and financial sectors, they have been flocking to professions in the health field, particularly veterinary medicine,” she said. “Why? The demands of professional training have not changed. But the practice setting has. Small animal clinics open from 9 a.m. to 6 p.m., six days a week, with no evening and no emergency hours have proliferated. Being a veterinarian has prestige, equivalent to that of a physician. Like some physicians there is considerable room for part-time and flexible work. The training period is less than that for doctors. Veterinarians work lower hours than MBAs and engage in more part-time work sooner in their professional lives.”

Anyone in this field knows that women now dominate the profession.  A man like myself is increasingly becoming a rare find, and this will be even more noticeable as time goes on.  Frankly I don't mind, as I've never really felt like medicine should be in the hands of one gender or another.  But as more women enter veterinary medicine it changes more than the look of a veterinary office.  As the articles mentioned, women want a better work/family balance, and this is resulting in changes in how veterinarians are employed and how practices are run.  This isn't a bad thing, just different.  And I've sometimes wondered why this gender switch is happening, so it's interesting to me to see a likely reason.

Speaking of females entering the profession, I'd like to welcome one to the blogosphere.  There is a new blog by a veterinary student (a woman, of course!) called Vogue Vet that exemplifies these differences.  You certainly will not find me discussing the fashionable accessories of a veterinarian!

Bonding With The Physician

I've come to a good understanding and bond with my own physician.  He's known what I do since I started seeing him and we'll sometimes talk about cases together.  I went to see him today and realized that veterinarians and human doctors have things in common besides our medical training.

He was running late today, and it was almost an hour from the time that I checked in until he came into the room.  Honestly, it didn't bother me.  I always bring a book or something to work on when I have a doctor's appointment, because there's usually a wait.  I'm also well aware of how your schedule can get off-kilter, so I'm very forgiving of other doctors' delays. 

When he entered he apologized for the wait.  Since we sometimes "talk shop" he explained one of the cases that delayed him.  He was seeing a man and talking to him about the health concern.  The patient's wife was also there and when the doctor was finished with her husband she said "Since I'm already here can you take a look at me too?"  I was a little floored by this, as any veterinarian can tell you that this is not uncommon in our profession.  Someone makes an appointment to bring their pet for a visit, then when they arrive they have more than just that one.  Sometimes the other pet is just there for "moral support".  But other times the client says "can you see my other pet also?"  We invariably do see them, as did my own doctor in his situation.  But since that was essentially an additional appointment it sets things behind.  Though I knew it happened to me and my colleagues, I never thought about it happening in the human field.

My doctor also talks to me differently than if I were a normal patient.  He treats me like a colleague, and discusses my cases in medical terms since I can understand on a level higher than most of the people he treats.  We talk about the symptoms and causes, and then discuss the treatment together.  However, I also realize that he knows more about human physiology and treatment than I do, so I defer to his expertise and don't presume to know as much as he does (something not all of my clients in the human medical profession seem to understand).  Really, it's kind of neat to talk to him on this level.

Basically the only difference between veterinarians and physicians is the species we treat.  And it's nice when that's recognized and those barriers come down.