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Thursday, December 30, 2010

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!

Friday, December 24, 2010

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!

Thursday, December 23, 2010

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.

Tuesday, December 21, 2010


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.

Saturday, December 18, 2010

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?

Friday, December 17, 2010

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!

Wednesday, December 15, 2010

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.

Saturday, December 11, 2010

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!

Friday, December 10, 2010

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.

Thursday, December 9, 2010

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.

Wednesday, December 8, 2010

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.

Tuesday, December 7, 2010

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.

Monday, December 6, 2010

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:
Broccoli leaves and flowerets
Collard greens
Dandelion greens (beware of lawn treatments)
Mustard greens
Sweet potatoes
Turnip greens
Yellow squash
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.

Friday, December 3, 2010

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!

Thursday, December 2, 2010

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.


Tuesday, November 30, 2010

Don't Share Your Dinner....SERIOUSLY!

My clinic received a big reminder why people should never share their meals with their pets.  Here in the US last Thursday was Thanksgiving.  To you non-Americans, this is an annual holiday in memory of one of the first colonies in the US after they survived a hard winter and gave thanks.  It's a time for getting together with family, being thankful for what we have, and eating lots of food.  Traditionally, the staple of the Thanksgiving meal is turkey, though lots of other things are also served.

Last week a client gave her seven pound yorkie a turkey leg and gravy.  Over the weekend she developed acute pancreatitis and has been in the clinic for the last couple of days.  She's stable, but is in serious condition and is very painful.  Pancreatitis is a common consequence of feeding fatty or rancid food to dogs, and is especially dangerous to small dogs because of their body size.  Most cases of pancreatitis that I have seen are due to people feeding or allowing their dog to eat food that they shouldn't.

I can't emphasize enough....don't feed human food to pets!  Yes, there are plenty of times when dogs and cats eat these foods without consequences.  I grew up feeding table scraps to our dogs (back before I knew better) and they did fine.  However, in over a dozen years in practice I've seen far too many problems after pets have had human food.

Simply put....DON'T DO IT!  Any reward you may get by sharing your meal with your doggie or kitty is not worth the risk of health problems and the subsequent often expensive veterinary visits.

And keep your fingers crossed for this little dog that we're treating.  She's doing okay but is far from being out of the woods.

Monday, November 29, 2010

Where Does Obligation End? Part 1

Recently we had a client visit one of our clinics (we're a multi-location practice) because she believed her dog had eaten some rat poison.  The doctor worked up a treatment plan and it was presented to the owner.  She said that she could not pay for the services.  She was offered Care Credit (a medical credit card here in the US), but said she wouldn't qualify.  She didn't have any other credit cards, and said that her check would bounce.  Basically she was offered every payment option we have (we don't do in-house billing and payment plans), but couldn't do any of them.  So treatment was not performed and she was referred to a local emergency clinic in hopes that they might be able to work out payment with her.  Her visit there ended up the same way, with her being unable to make any payment and the emergency clinic declining to treat without being paid.

Almost two weeks later I saw her dog for acute vomiting.  The dog was acting fine with no signs of having had any bleeding problems (the main complication of most rat poisons).  She was on a health care plan with us that allowed some blood testing at no additional cost (it doesn't cover treatments, just basic preventative care), so we ran these and everything came back normal.  Since the owner couldn't afford any other diagnostics I put the dog on some antinausea drugs and sent her home for observation.  What else could we do?

During all of this mess the client has been belligerent and confrontational.  She has accused us and the emergency clinic of "neglect and abuse" for "refusing to treat" her dog.  She has made statements that we are "killing her dog", that we "don't care about animals", and everyone is "just about the g**d*** money."  She is threatening legal action if her dog dies (it's been close to four weeks now, so the chances of that happening are slim) and has called us repeatedly with complaints and abusive language.  In her opinion we should have treated her dog regardless of her financial situation.

Personally I'm not worried in the least about this client, as I know that we and the emergency clinic offered every appropriate action and treatment.  We have documented all conversations and declined services, so she has absolutely no legal ground for a suit.  However, it does bring up an interesting question that I'm putting to a poll.  Does a veterinarian (or by extension, any doctor) have an obligation to treat a patient regardless of the ability to pay?  Every veterinarian sees pets who don't get needed treatment because the owner can't afford it.  In many cases these pets end up suffering or have chronic problems, despite the fact that have the ability to treat them.  According to this owner's comments, we should be treating them anyway.

So let's see what the poll says and then we'll revisit this topic in a little over a month.

Tuesday, November 23, 2010

Pain In The Neck

Back in September I saw a dog for a swelling on the neck.  Apparently the dog had fallen while running back in the Spring, and had landed on a sharp rock.  Since then she .had a bloody swelling on the left side of her neck where she hit the rock.  A previous veterinarian had thought this was a hematoma (blood swelling or clot under the skin) and various treatments hadn't helped.  So she came to me for a second opinion.

I noticed that there was a slight draining tract and some inflamed tissue that was potentially preventing it from closing.  Whatever the cause, we needed to do surgery to try and resolve the issue.  The owner agreed to the procedure, and a couple of weeks later one of my associates performed the surgery. Now keep in mind that this was about four months after the original injury and the problem was still there.

During the surgery my associate found several small slivers of wood in the wound.  She removed them and explored the area, not finding any more pieces.  The site was closed, leaving an area for excessive fluid to drain.  A couple of weeks later I looked at the incision and removed the sutures.  At that time everything looked like it was healing well.  The scab came shortly thereafter and the owner was satisfied.

Then over the last week a spot reappeared in the same location and started to ooze fluid like before.  I looked at it yesterday and felt firm swelling under the skin very similar to the first visit.  There could have been something left behind, though I know my associate is skilled and thorough.  It was also possible that there was some dead tissue that was trapped under the skin.  Whatever the cause, I knew we had to do a second surgery, and likely be more aggressive this time. 

Today I did that surgery and removed the entire tissue around the draining tract. I wanted to make sure we didn't leave anything behind, and so excised the entire area.  It was a bit tricky since I was right next to the trachea and pretty close to the region of the jugular vein.  Even so, I was able to carefully dissect down and around the area and remove the inflamed tissue.  The closure was routine and the dog recovered normally. Afterward I cut open the tissue and found another piece of wood.  This one must have been deep enough that it wasn't easily noticed on the first surgery and wend hidden until it created another tract.  This time, though, because of how much tissue I removed I'm confident that everything will be fine and we won't see another return of this problem.

The whole thing seems like a pretty crazy and freak accident.  Apparently when the dog fell and hit her neck several splinters of wood punctured the skin and were driven deep.  Because the wood wasn't obvious or sticking out, there wasn't an immediate reason to go in surgically.  So these pieces caused a reaction in the body that resulted in a draining tract, and it took six months before the final piece was removed.

Not sure that there's a great lesson here, but I thought it was an interesting case.

Monday, November 22, 2010

No Blame In Cancer

Here's a question from Stefanie...

I just recently found out that my 14 year old Queensland Heeler/Australian Shepherd dog has a squamous cell carcinoma in her throat. It is attached to her soft palate and left tonsil and is quite large. (I was shown a picture of it) To quote the biopsy results "poorly differentiated, aggressive, locally invasive". Since she is 14 - after discussing options with the vet (her recommendations were referral to an oncologist, "debulking" the tumor which would buy some time but not necessarily prevent it from growing back, or just keeping her happy and comfortable for as long as possible). I was told she has 3-6 months and the tumor will likely eventually cut off her airway. I chose option three - keeping her happy and comfortable and will put her down when the gasping for air and choking become much worse than what they are now.

My question is - did I do something that potentially caused this cancerous tumor in her throat? I have to tell you - she has always enjoyed chewing/eating stuffed animal parts, sticks, other debris in the yard and anything she can get a hold of in the house if I am not paying attention. Because of this - in order to help her pass these items - for the past several years - I have given her petroleum jelly (less than a tsp) once a day. My concern was always to prevent intestinal blockage - so I never even considered the possibility that it may cause her harm.

Any light you can shed on this would be appreciated. I love this dog dearly - she has been my constant companion since she was 10 weeks old and I hate the thought that I may have caused her harm, but on the other hand - would like to be educated so that I do not repeat the same mistake for any future dogs I may care for.

First I have to say that I'm very sorry for her medical problems.  This type of cancer usually is very aggressive and this is a difficult location to have it.  I would agree that the best thing to do at this point is to make her as comfortable as possible and enjoy the time you have left.

Let me set your mind at ease that you didn't cause this.  We don't have good data in pets regarding environmental factors leading to cancer, unlike human medicine where there are numerous factors identified that can increase or decrease cancer risks.  There are some things that can increase risks in pets, such as feline leukemia, subcutaneous injections or punctures, and certain toxins or radiation (as in humans).  But most of the time cancer is due to genetic and physiological factors that we have no control over.

In a nutshell, a tumor is a particular type of cell that grows uncontrollably.  Each cell in the body has mechanisms that tell it to stop reproducing or lead to the cell's death if there is damage.  Much of this protection is at the level of DNA, though there are external factors such as immune cells that seek out and destroy cancerous cells.  In order for a tumor to develop, all of these defenses must fail.  Truthfully, it's a wonder of nature that we don't see much more widespread cancer.  But you should be aware that in most cases of cancer in pets there is no single, preventable cause.  This means that for better or for worse, you couldn't have prevented this from happening to your dog.

To also specifically address your concern, I've never seen any link between petroleum jelly and cancer in dogs.  Also, in a dog this size a teaspoon or less probably didn't significantly help with lubrication.  But even if it didn't help, I can't think of any reason why it caused any harm.

Fourteen years is a great life span for any dog.  I lost my own dog to cancer a few months ago and she was only five.  I can certainly understand what you're going through.  It's not easy to go through this, but know that you have given her a great and long life.  Enjoy the time left with no regrets.

Wednesday, November 17, 2010

Heartworm Resistance?

There is a potentially emerging problem here in the US....potential resistance of heartworms to current preventative medicines.  While it's not time to panic, there is reason for concern.

One of the worst areas in the US for heartworm disease is the lower Mississippi River region.  The presence of water as well as high temperatures and humidity throughout the year make it an excellent breeding ground for the mosquitoes that carry heartworm disease.  In the last few years there have been several cases reported of dogs who had been consistently on prevention yet still developed heartworm disease.  It's gone beyond a couple of questionable cases to the point that top parasitologists are investigating the possibility of resistance.

All of this fear is currently speculation and hasn't been confirmed.  It's also only been a worry in certain areas of the Mississippi where heartworm disease is the highest.  There is enough prevalence of the parasite in this area that breeding and reproduction is rapid, allowing many generations in a short period of time.  If anywhere was going to show a resistant population of heartworms, this would be it.  However, before we panic and run around like Chicken Little, there is still much study and research to be done.

In a worse case scenario, development of resistance to current preventions would be a major health issue.  Unfortunately, only about 56% of American dogs are on consistent heartworm prevention, much less than it should be.  However, those dogs are well protected.  If medicine starts being ineffective, even these dogs could be at risk.  Then you would have pet owners who are doing the right thing suddenly learn that their pets have a potentially fatal disease that is expensive and somewhat risky to treat.  There is the potential for a real canine health crisis if this turns out to be true and the resistance strains spread to other parts of the country.

This is definitely a topic to continue watching closely.

Sunday, November 14, 2010

Sick Feral Kittens

Here's a question from Patti....

Back in August I spotted a tiny kitten lounging on my driveway. I felt sorry for it because of the heat and decided to give it water and a bit of food. (I know not to, but it was a kitten!) Anyway I set it out there, the kitten ran off, then I saw what turned out to be mama cat and another kitten. I opted to continue feeding all three of them. Mama seemed to bail after about a month or so. It was getting colder outside, so I fashioned an old cat carrier into a shelter with a blanket. They use it too. So here is the problem. The kittens both have been sneezing and the smallest one is really congested. They are so skittish, so I can't grab them up to take them to the vet. I talk to them to try to put them at ease. They will allow me to play with them using a toy I rigged up on a piece of yarn, as long as the railing around my front porch is between us.| Do you know of a way that I personally can capture them? Is there a humane device I can rent, or do I have to get animal control involved?

First of all, I never recommend feeding or taking care of strays. I know it pulls at your heart strings, but feeding them encourages them to come around and can lead to a small population of cats at your place.  Stray cats have a high incidence of leukemia and feline AIDS and when they come together there is an increased risk of fighting.  Depending on where you live, food outside can also encourage raccoons, skunks or other wild animals, some of which can carry rabies.  Though rare in cats, rabies can happen in them and you certainly don't want to be exposed to that.

Now all of that being said, there is something that you can do. I don't know that you can rent them, but there are humane traps that capture animals alive and safely.  You should be able to get them at a home supply place like Lowes or Home Depot, as well as possibly Tractor Supply or garden centers.  You put food in the back and when they go inside the door closes, trapping them.  Unfortunately, you may catch something besides the kittens, so be aware of that.  If that doesn't work you may have to call animal control.

When the kittens are taken in, have them tested for feline leukemia and AIDS.  If they are positive, their chances of getting better are very low, and you wouldn't want to release them back into the wild as they could spread the disease.  As hard as it may seem, the best thing to do in these cases is euthanize them.

I hope this helps.  Good luck!

Saturday, November 13, 2010

Post-Bone Problems

Donna sent this in...

 I am writing in reference to my 7 mo. old English Mastiff. I recently gave him a large raw cow bone on Monday afternoon and the following Wed. he became ill. I fed him his kibble which he started hacking and proceeded to throw all that up. He started to  shiver, hack just general not feeling well.  I took him to our new vet and my pup did have an elevated temp. 103. the vet said he had a bacterial infection poss. e-coli, salmonella. He kept him overnight and I picked him up the next morning with the only instructions to give him his antibiotics and pain meds, Tramadol 2 50mg every 12 hrs.  There was no bloodwork or x-rays taken. I got my pup to eat some boiled chicken and rice shortly after I got him home (about noonish)" then later that evening some kibble with the same c & r topper.  He finally moved his bowels, very small amount which had 6 large bone chunks in them. I asked the vet upon leaving about his coughing hacking and he said he would either hack up the shards or pass them. about 11 pm. I gave him 1/ pc of bread and after that is when he passed them. He is still hacking and gagging as if trying to throw up something or dislodge. I  called my vet about x-raying and he said to wait and let the meds take effect. He is eating but I am concerned that there may still be something lodge somewhere.  I really dislike taking a wait and see approach if something could be there and then have a life or death situation on my hands.  he is also limping terribly on his right front leg, no connection I am sure but has gotten severely worse since being at the vets.  in relation my pup also has generalized Demodectic mange and a 4" hygroma on his right knee. Do I have reasons for concern or am I being an overprotective paranoid furmom?

Donna, you've mentioned several things and I'll try to at least touch on all of them.

I don't like giving bones to dogs as I've seen too many problems with them.  Raw bones can indeed carry bacteria, and can lead to infections like your dog may have.  Salmonella is only one of the bacteria that can be a problem, and these can be difficult infections. Bone shards can also cause constipation or intestinal irritation, as well as potentially become obstructed if the pieces are large enough.  Bones can chip teeth and even get stuck on teeth or the roof of the mouth.  I really, really don't like giving bones to pets, even though it's the stereotypical thing to give to dogs.

I don't want to second-guess your vet since I'm not able to examine your pet myself.  I will usually defer to my colleagues when I'm not involved in the situation.  Personally, however, I would consider taking some radiographs, especially if there seems to be continued hacking or gagging.  This is a case where I would consider bone shards being a problem and would want to look for them.  Bone shows up well on an x-ray, so if they are there it shouldn't be difficult to find.  Blood testing may not be absolutely necessary initially, but it's never a bad idea.  If the problem is persisting I would definitely want to run these tests.

The other problems won't be related.  Limping is certainly not related to eating the bone, and could be anything from developmental problems (not uncommon in large and giant breed puppies) to a sprain or bruise.  If it's persisting or worsening I'd want to take radiographs of the affected leg.  Demodex is also not related, but if widespread should be treated.  It's a little unusual to have a hygroma at seven months old, but this is a common problem in large dogs.

Donna, I can't say whether or not you need to be extremely concerned as I can't examine your pet.  However, the potential for a serious problem exists.  Salmonella and E. coli infections can be serious and lead to severe complications.  A bone obstruction can be life-threatening and require emergency surgery.  If it's been 2-3 days since starting medication and there's no signs of improvement, I'd want to run full blood tests (chemistry panel and CBC) and get some x-rays of the abdomen and chest/neck.  If your dog is worsening since starting medications I'd want him seen as quickly as possible.

I hope this helps your decision.  Good luck with him and I hope everything turns out okay.

Thursday, November 11, 2010

Normal Play?

Yesterday I had a client that was worried about her seven month old puppy being aggressive.  In the exam room the dog was energetic and sweet with no signs of behavioral problems.  As I questioned the owner and delved into the behaviors I realized that the owner was describing normal play behaviors.  It's actually not uncommon for an average pet owner to be confused, as some play behaviors in dogs can appear aggressive.  And since animal behavior is a strong interest of mine, that's today's blog topic.

Here is a recent picture of my two dogs:  Inara on the left and Yvaine on the right.

Looks pretty fearsome, right?  That's actually them just playing around and neither one is aggressive.  In animals, play behavior is often practice for life as an adult.  Carnivores will practice stalking and hunting.  Social animals will practice behaviors that will determine social hierarchies.  It's just like human children playing "house" or pretending to have jobs.  Childhood is a good time for any animal to start learning and honing skills they will need to be successful later in life.  So in pets you will see behaviors that may seem like hunting, aggression, and so on.

So what indicates play?  There are some key behaviors and body languages you can look for.
1.  The most common and universal behavior is the "play bow".  In dog language this is an invitation to play.  The front end will be down and the hind end raised.  Whenever you see this the dog is in play mode, even if there are seemingly aggressive vocalizations.

2.  Another common behavior is a "play face".  This is universal across animal species.  The eyes are wide, the mouth somewhat open, ears normally erect and alert, and the face relaxed.  Like the play bow, this is a sign of playfulness.

3.  Wagging tails are also a good sign.  However, some dogs will wag when they're nervous or uncertain.  If a wagging tail is seen with the above behaviors it's play.  If there are raised hackles, fierce barking, or bite attempts, it's a sign that the dog is uncertain how to react to the situation.
4.  Many dogs will bounce from side to side or forwards and backwards when they are wanting play.  Like the play bow this is an invitation behavior.  Basically the dog is saying "Hey, come get me!  Play with me!"
5.  Barking and even growling, when combined with the above behaviors, is merely an indication of play.  It's like kids yelling and shouting at each other during wrestling or a ball game.
6. Dogs don't have hands and fingers to manipulate their environment.  Instead they use their mouths and teeth to interact and grab things.  So biting or grabbing during play is common and normal.  It may not be desired, and should be discouraged and trained out of the dog.  However, it's not a sign of aggression.

Looking for these behaviors should tell you when a dog is playing.  If you're worried about aggression here are some signs to look for.
1. Raised hair on the back and neck (though Inara will do this during play sometimes, so with her I've had to look at the other behaviors).
2.  Tail straight or lowered and not wagging.
3.  Ears back or down.
4.  Persistent growling for several seconds or minutes and not just for brief spurts.
5.  Lunging with fierce barking.

Dog's don't commonly show all of the signs at once for any behavior, so look for some of the signs and use your best judgment. If you don't know the dog and there are any signs of aggression, please do not interact with that dog!  If you're worried about your own dog's behaviors, find a vet who is skilled with animal behavior and have him or her evaluated.

Tuesday, November 9, 2010

You've Worked Too Long As A Vet When....

Part of my goal for this blog is to peel back the curtain of veterinary medicine and let people see what the life of an average vet is like. For those outside of the profession this may be a bit of an eye-opener at times as you see things that you never realized. This may be another of those times.

A friend of mine who is also a vet comes up with some great humorous lists that always have surprising truth in them. I saw him post this list a few days ago and really laughed at it. There are many things here that non-veterinarians (or their staff) simply won't understand or find funny. But those of you who have been in the profession for any length of time will likely laugh out loud. One of the most amusing thing about this list is that it is completely and utterly true...and to those of us in veterinary medicine, that truth is what makes it funny. Enjoy!


You look at a cardboard box and recognize its coffin potential.

You go out to a club and when the black light comes on you check yourself for ringworm.

You can eat lunch while cleaning up a Parvo blowout.

You can keep your milkshake frozen in the freezer around the dead bodies.

You take your kids temperature and think 102 is normal.

After seeing what goes into the washing machine at work, your own laundry doesn't seem so dirty.

Your work clothes look like your pajamas.

You open your lunch container and find a spleen.

You have no problem eating your lunch on the wet sink where they have just finished a necropsy.

All of your pets are either 3 legged, lame, or blind in one eye.

You've done an anal probe on a bird.

You can detect maggots at 100 paces, just by the smell.

To you, pets are more recognizable than their owners are.

When eating and you find a hair in your food, you pull it out and keep eating.

The first thing you wonder when opening up a big cat abscess is, "Where are the Ritz crackers?"

You cough up hairballs.

You are the first one in the hospital in the morning and you don't notice the smell.

You start to like the smell of anal glands.

You can play connect the dots with all of your scars and puncture wounds.

When NORMAL people won't eat meals with you.

You get the flu and begin to sympathize with the Parvo dog.

Your paycheck barely covers your food bill, but ALL of your animals eat a premium brand food!

Your medicine cabinet holds nothing but animal medications.

You have ever picked up Poop with your bare hands.

You can put a muzzle on with one hand tied behind your back.

You know that "pink juice" and "blue juice" are not flavors of kool-aid.

You get a rash from just LOOKING at a Shar-Pei.

You can take a dog's rectal temperature without looking.

No one asks you what you did at work today while you're eating dinner.

Monday, November 8, 2010

Cancerous Eye

Good week for reader questions! Here's one from Darlene.

Our cat, Tig, is a 13 year old (indoor only) domestic short haired cat. She has been in very good health until the last month or so. We began to notice the color of her iris began to get darker. In addition, sometimes her pupil began to stay open wider than the other pupil in the other eye. She has not shown any signs of pain. She does not wash that eye anymore and will let you pet her face near that eye. We recently took her to the vet to be examined.
They informed us she likely has an iris melanoma with glaucoma in that eye. They have recommended she have an enucleation procedure performed. They would have the eye sent to UGA to see if the tumors in the eye were Cancerous. We have become more comfortable with the removal of her eye. However, we are very concerned that if it is Cancerous, has it spread to her other eye or any other part of her? This has all happened so fast with the change in eye color just in a month so we are very concerned if it is cancer and if the cancer has spread.
Is there a way to screen her for cancer to find out if it is through out her body? I have attached her photograph. Sadly, if she does have cancer in the rest of her body we would not like to put her through the procedure removing her eye and the cost to us for only extended her life briefly.

All good questions, Darlene. I didn't include the pictures in this post because they weren't as clear as I would like, and it's hard to tell as much as I would like. But I can see some potential issues, including the darkening of the iris.

It wouldn't be possible to tell 100% for certain that this is a melanoma without sending tissue samples off, though this certainly sounds and looks like the main possibility. If a tumor is growing on the iris it can affect the outflow of fluid from the eye, leading to glaucoma. Glaucoma by itself is pretty serious and can lead to permanent blindness as well as being painful. Add a likely tumor to the issue and you have a bad situation. Either one of these problems alone could warrant removing the eye, and when you combine them the best solution is to have the surgery done.

Pets do very well with only one eye. It's a bit harder for cats because of the loss of depth perception, making it harder for them to judge distance when they're climbing and jumping. But they quickly learn how to compensate and live with the difference. I've removed many eyes myself, and certainly think it's a valid procedure and better than the alternative.

So let's talk about the other concern. What about metastasis (spread to other locations)? This is a valid question, and one that should be examined. However, there is no way to be completely certain that a tumor hasn't spread. All you can do is your best due diligence, examine as much as you can, and pray that there isn't anything hidden. Some tumors are small enough that we can't detect them with any means, and there aren't simple blood tests for most forms of cancer. In a situation like this you want to perform a full blood chemistry and blood cell count, looking for signs of organ abnormalities and alterations in the white blood cells. You also want to do chest radiographs as the lungs are a common place for tumors to spread. If these tests are normal, you've done the best you can to screen for cancer outside of going to a specialty clinic and having a CT or MRI performed on the pet.

If there are abnormalities, especially tumors in the chest, I would agree that major surgery like enucleation wouldn't help improve longevity and would be unnecessary. If everything is normal, I would recommend having the surgery done as soon as possible. There will always be the chance that something was missed on the screening and you may have tumors appear later, but that's a risk that everyone takes when dealing with cancer.

I hope this helps with the questions. Good luck!

Sunday, November 7, 2010

Painful Swallowing

Here's a case sent in by Kristin...

I have an 8 month old Maltipoo that I rescued 4 months ago. He was late getting his shots because the previous owners did not give him his shots. He has had his 6 in 1 shots but has not received Bordatella because I thought it was included in the 6 in 1.

Recently he has been sick. Slight cough, slight fever so I took him to the vet and he has been on antibiotics for approximately a week.

Nothing too abnormal about this scenario so far right? Well, here is where it gets interesting.
I told the vet the first thing I noticed about him being sick was an unusual behavior. When he would attempt to eat he would extend his front left leg out in front of him and whine in pain. He went off his feed entirely just prior to me taking him to the vet for about 3 days. The vet prescribed him doxycycline twice a day and he seems better in the sense that he is not lethargic, wants to play. However he still does not want to eat and still exhibits discomfort when he does try to eat.

I know you say its unlikely he would have anything stuck in his throat-as did my vet but he is acting normal with exception to this behavior and he refuses to eat. Whenever he does attempt to eat he extends that front leg and it seems painful to him. I've tried force feeding him baby food, canned food and soft table scraps. He wants to eat but then he remembers that its going to hurt and only eats a very little when hes practically starving.

If he did have kennel cough, wouldn't a weeks worth of doxy get him back on track-why is he still experiencing pain? Any thoughts, advise or experience you may have had with these symptoms would be so greatly appreciated. 

This doesn't sound like kennel cough to me, though I can't say for certain without having seen the patient.  Kennel cough normally causes a dry, resonant cough that can be easily stimulated with palpation of the trachea.  Doxycycline is a great antibiotic for this kind of infection, though it can take 10-14 days to fully resolve a case.  The pain and odd behavior that you describe isn't something that we see with kennel cough or other respiratory infections.

I'm a bit puzzled as to what could be causing the behavior based only on the description.  It sounds like there is pain in swallowing, which may be related to a problem in the esophagus. I would want to rule out some kind of stricture or narrowing of the esophagus, which can be very difficult to determine in a general practice.  The two best ways are with an endoscope or fluoroscopy.  Fluoroscopy involves a moving x-ray taken while a pet is in the act of swallowing, and requires special radiology equipment that you won't find in a private general practice.  Some veterinarians do have endoscopes, so this might be another option.

However, a simpler option could be pain from an inflamed throat or esophagus, similar to what happens to us when we have a sore throat.  This should improve with antibiotics, though it may take longer than a week.  Analgesics or steroids prescribed by your vet could also help.  I would recommending talking to your vet about this option first, and if you don't start seeing results within a few days look into further diagnostics.  Keep in mind that such diagnostics may involve being referred to a specialist and will not be cheap, but at the same time he can't go for long without eating easily.

Make sure to do follow-ups with your vet.  Good luck!

Sunday, October 31, 2010

Chupacabra Revealed

Here's a story that's perfect for Halloween.

For those who aren't into cryptozoology, the chupacabra is a creature seen in parts of the Americas that has a legendary status similar to Bigfoot and the Loch Ness Monster. The name literally means "goat sucker" based on its behavior of drinking the blood of goats and other farm animals. The Wikipedia entry on chupacabras lists the following description:  
The most common description of chupacabras is a reptile-like being, appearing to have leathery or scaly greenish-gray skin and sharp spines or quills running down its back.This form stands approximately 3 to 4 feet (1 to 1.2 m) high, and stands and hops in a similar fashion to a kangaroo. In at least one sighting, the creature was reported to hop 20 feet (6 m). This variety is said to have a dog or panther-like nose and face, a forked tongue, and large fangs. It is said to hiss and screech when alarmed, as well as leave behind a sulfuric stench. When it screeches, some reports assert that the chupacabras' eyes glow an unusual red which gives the witnesses nausea.

Here are some images of what the chupacabra is supposed to look like...

There is no scientific proof for this creature, though biologists and other scientists have tried to prove or disprove its existence.  As shown in a recent Discovery News article, most mainstream scientists believe that sightings of a chupacabra are actually a case of mistaken identity with the actual creature being an extremely mange-ridden coyote or wild dog.  Compare the images above to the pictures and video capture below.
I've always had a passing interest in cryptids, having learned a lot about the Yeti and Sasquatch as a child and having been to Inverness and Loch Ness as a teenager.  Besides my interest in the fantastic and mythological, I also find these creatures intriguing because of my background as a biologist and veterinarian.  In the case of the chupacabra, the thing that fascinates me the most is that the type of mange scientists believe are affecting these canids is scabies (Sarcoptes scabiei).  I've treated many cases of these mites!

This is actually a not-uncommon external parasite of dogs and can affect pet dogs.  In the huge majority of cases the pets see us vets long before they get to the point of complete baldness, as the mite causes intense itching.  It's also a mite that is relatively easy to treat through several methods and is not considered a major health concern. Yet in wild animals the mite can lead to severe skin disorders and even death due to weakness and secondary infection.

Does the chupacabra actually exist?  My instincts say no, though I'm sure there are cryptozoology aficionados who can argue otherwise.  Other cryptids?  I think the jury is still out on some of them.  And frankly, I like the idea of there still being some mysteries left in the world.  It keeps things from being too boring.

Happy Halloween!