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.

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.

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.

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.

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.

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!

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.