Musings of a Veterinarian

Archive for the ‘General’

Hope for Cats with Snots, Snuffles, and Snorks

April 14, 2010 By: Dr. K Category: For Vets, General

How do you remove dried snot from painted walls without damaging the paint? You can’t. At least that’s my experience with my chronic snotting, snuffling, sneezing, snorking cat. Winston has successfully plastered my walls with copious amounts of mucous with a holding power rivaling the largest tube of gorilla glue. If you have one of these snorkers in your house, there is hope!

I recently attended a veterinary conference lecture that focused on these cats by Cynthia Stubbs, DVM, DACVIM. We all know snot-nosed cats can prove difficult to manage for both veterinarians and pet owners. Once the appropriate diagnostics are performed to rule out some of the more easy to treat issues, many pet owners are faced with the choice of advanced and often expensive diagnostics. While I still strongly recommend performing a vast array of diagnostics to get to the heart of the disease, many times cats suffer from difficult to diagnose rhinitis and sinusitis that can be exacerbated by respiratory infections. There is a probable association between chronic snorkers and chronic infections with herpes and calicivirus. Both herpes and calicivirus attack nasal and upper airway mucosa, causing chronic inflammation that can lead to nasal discharge and destruction of the delicate nasal bones that sit inside the nasal passages. This correlation has lead Dr. Stubbs to pursue both palliative and curative treatments.

Dr. Stubbs suggested one such treatment involves giving affected cats intranasal bivalent vaccinations against herpes and calicivirus. The intranasal delivery is purported to increase local mucosal immunity and therefore decrease the inflammation in the nose. Dr. Stubbs reported some cats needed only the vaccine on an every 3-6 month basis for near complete relief. The off-label use of the vaccine does not confer any immunity to panleukopenia, so Dr. Stubbs recommended also giving the traditional subcutaneous trivalent FVRCP vaccine. In addition, Dr. Stubbs bravely uses the anti-inflammatory antibiotic doxycycline along with the NSAID piroxicam to provide additional symptomatic support. Word to the wise: Non-liquid forms of doxycycline are known to cause esophageal stricture in cats and piroxicam should not be used in cats with kidney disease.

I am planning on trialing the intranasal vaccine in my own snorker. We’ve tried multiple antibiotics – no small feat given Winston is a perceptive, neurotic, inflammatory bowel disease cat. Nothing has alleviated his six years of nasal congestion. I will certainly follow-up in future postings.

Diagnostics Performed in Nasal Discharge in Cats

  • Complete physical exam
  • Complete bloodwork, urinalysis, Felv/FIV testing, +/- coagulation testing
  • Blood pressures, particularly if nasal discharge is hemorrhagic
  • Nasal cytology, culture, and biopsy
  • Viral detection tests
  • X-rays, CT scans, Rhinoscopy
  • Nasal Flushes

Common Diagnoses In Nasal Discharge in Cats

  • Dental disease – very common
  • Rhinitis/Sinusitis – very common
  • Nasal foreign bodies
  • Cancer
  • Nasopharyngeal Polyps
  • Infection: Bacterial, Viral, Fungal, Parasites – common either as primary or secondary diseases
  • Trauma
  • Hypertension or bleeding disorders

What Were You Thinking?!?

February 14, 2010 By: Dr. K Category: General

I received a call the other night from a distraught pet owner who sheepishly approached our conversation about his 5lb puppy. “I did something really stupid.” Uh-oh. I have heard a lot of crazy things so I was prepared for just about anything he was going to tell me. His voice cracked as he slowly said, “I can’t believe I thought this was a good idea.” I started to squirm then he admitted he gave his puppy “a few tablespoons of wine” and now realized it was an idiotic decision. Lethargy, and probably a drunken stupor, hit the puppy hard.

I decided the puppy, who was then walking around as the effects of the alcohol wore off, seemed stable. We spoke about what to expect and what clinical signs required emergency care. I’ve never heard back from him. After I hung up and realized I didn’t even ask him why he did it. Truthfully, I don’t think he even knew. I gave this guy the benefit of the doubt. We’ve all made stupid, thoughtless decisions which weigh heavily in our stomachs as we mull the horrible decision and try to rectify it. He clearly didn’t think. Any rational person would know not to feed any animal, let alone a small puppy, alcohol. He at least redeemed himself by calling my office to find out what he should do. Perhaps I was too lax, but I trust this man will never make this mistake again.

I like tangents and this case got me thinking about how I could measure a blood alcohol content (BAC) in a domestic pet. Breathalyzer is out. A quick search on Google failed to yield any available bedside blood alcohol tests. Laboratory tests exist but shipment of blood for a BAC would take too much time. Any veterinarian should provide decontamination and supportive care to any alcohol poisoning suspect pending any bloodwork. The animal would most likely have either recovered or died while waiting for BAC lab results.

I then tried to calculate the puppy’s BAC using The Original Blood Calculator. A full 5 oz glass of wine would have given Fido a fatal BAC of 0.813%. Two tablespoons equal 1 oz of wine, so Fido’s BAC may have been closer to 0.16%. While it is clinically interesting to speculate, this value may or may not be close to accurate given varying metabolisms between humans and dogs.

Animals entrust us with their care. Be smart and don’t abuse it by giving them alcohol. For more information on alcohol poisoning in domestic pets, check out this article on VIN!

The Wonder of a Three-Legged Dog

February 10, 2010 By: Dr. K Category: General

Faced with a leg amputation to treat bone cancer, dog owners can experience trepidation over their pooch’s outcome. This scenario is playing out for one couple at my practice who’s six year old golden retriever, named Goldie Hawn, has been diagnosed with bone cancer in her left femur.  Given their amazing ability to walk on three legs, amputation is the treatment of choice. Amputation will at least provide palliative treatment of her tumor and at best a cure. Amputation is permanent which makes the stakes even higher. Goldie’s owners have that knot-in-their-stomach nervousness but a little education can alleviate some fears.

From a veterinarian’s perspective, it’s easy to discuss the surgery, recovery time, and varying anticipated outcomes following a leg amputation. What we aren’t always ready for are those questions regarding specific parts of the dog’s quality of life. I smiled as Goldie’s owner asked how she would be able to “squat to pee” and if she would “have a stump”. I walked them through preoperative and postoperative care, glancing over the surgery itself when they told me they couldn’t handle the details. I recommended they watch videos on youtube.com of three-legged dogs to get an idea of what to expect. Knowledge is power.

Dogs never cease to amaze me with their ability to cope. Many dogs swiftly adapt to their tripod status. It seems hind leg amputees ambulate better than fore leg amputees but both still motor along with the best of them. Check out these videos!

Fore Leg Amputee Playing Frisbee

Hind Leg Amputee Competing in FlyBall

Balanced Home-Cooked Diets for Pets

February 03, 2010 By: Dr. K Category: General

I am generally not a fan of home-cooked diets for pets because, too often, I have seen pet owners fail to provide a balanced diet. Now, I’m not talking about the folks who do their research, provide a variety of nutrients, and add supplements. I am talking about the owners who report their precious Fluffy just won’t eat anything but roast chicken and green beans. Merely adding a veterinary or human multivitamin to a diet does not make it balanced as those products are labeled for use in addition to an already balanced diet.

The dangers of an unbalanced diet are multiple. Nutrient deficiencies can result in anemia, skin issues, gastrointestinal issues, nerve conduction problems, and immunosuppression among many other medical conditions. It is crucial that pet owners who want to make food for Fluffy do it well. Many of the home-cooked diet recipes that came out from companies like Hill’s Pet Nutrition about 10 years ago have since been deemed unbalanced and are no longer recommended although you can still find recipes circulating the web. A Google search yields pages and pages of scientific, non-scientific, and opinionated recommendations on what to feed pets. With all this information, it can be difficult for pet owners to know which recommendations to follow.

As a general practitioner, formulating a diet is something I could do with the guide of a nutrition book and many calculations but is beyond my comfort zone. When faced with folks who have questions on how to provide a diet for their pets, I state the easiest way to achieve a balanced diet is to feed a balanced commercial food. If the owner finds this undesirable, I talk about the other two options: Consult a veterinary nutritionist or use a veterinary nutritional website to find a diet that fits the pet’s needs.

Owners can search the American College of Veterinary Nutrition to find a veterinary nutritionist. If that seems like too much work then they should check out these two websites below. I like both of these sites because they personalize diets on an individual pet basis.

PetDIETS.com was developed by a veterinary nutritionist and can provide specific diets for healthy and sick pets. These nutritionists can recommend a home-made diet, a commercial diet, or both depending on the pet’s nutritional needs.

BalanceIT.com allows pet owners to choose the protein and carbohydrate sources they wish to feed their pets and creates a supplement based on a recipes the owner purchases. This is great for folks with pets with GI sensitivities or skin issues who have already been feeding an unbalanced diet. It allows them to continue feeding their current diet while adding supplements to make it balanced. I really love this one.

Antifreeze Intoxication: What You Really Need to Know

January 13, 2010 By: Dr. K Category: General

Cold weather means snow, hot chocolate, and car problems. That puddle of antifreeze in the driveway could mean more than car trouble. Dogs can’t resist the sugary taste of antifreeze and consumption can lead to big problems for your pooch. Cats are less likely to lap up antifreeze but, if they do, the same fate awaits.

The main ingredient in antifreeze is ethylene glycol, an alcohol. Once ingested, ethylene glycol is rapidly absorbed in the GI tract, typically within 1-3 hours. The first 12 hours after ingestion pets will be intoxicated by the alcohol and therefore, may behave like they’re drunk. Ataxia (stumbling and falling), seizures, stupor, and coma can occur.  Ethylene glycol is then broken down to glycoaldehyde → glycolic acid→ glyoxylic acid → oxalic acid, with different stages of disease occurring with the different metabolites.

Glycolic acid is highly toxic as it inhibits cellular energy metabolism and causes a severe metabolic acidosis. This can lead to cardiovascular collapse evidenced by high heart rate, pulmonary edema, and heart failure. If your pet survives these first two stages, it will contend with kidney failure caused by the end product of ethylene glycol metabolism, oxalic acid. Kidney failure typically occurs 24-72 hours following ingestion in dogs and 12-24 hours in cats. Oxalic acid causes kidney necrosis, or death, along with swelling. All three stages of toxicity can overlap making it difficult for the veterinarian to determine exactly where the pet is in the disease process.

If you suspect your pet has consumed antifreeze, you need to contact your veterinarian immediately. Diagnosis of ethylene glycol ingestion is made largely based on history and clinical signs as well as laboratory abnormalities. Metabolic acidosis, low blood calcium, and calcium oxalate crystals in the urine are typically diagnostic. These urine crystals can be present in the urine of nonaffected dogs and cats but should be held in high suspicion in animals with other symptoms. A blood or urine test exists for ethylene glycol, but is only available at certain laboratories and results may not be timely. Additionally, these levels are only detectable for up to 76 hours post ingestion.

Aggressive medical therapy is required. Aggressive diuresis with intravenous fluids is indicated. If ingestion recently occurred, the metabolism of ethylene glycol should be prevented by using compounds like 4-methylpyrazole (more widely used) or ethanol. Both compounds inhibit alcohol dehydrogenase, the main enzyme that begins the breakdown of ethylene glycol. In addition, drugs like thiamine and pyridoxine are used to prevent oxalate crystal formation. Urine output must be monitored closely. Some patients require hemodialysis or peritoneal dialysis.

Prognosis for animals treated in the early stage of ethylene glycol intoxication is guarded to good when appropriate treatment is instituted. Prognosis is poor for animals who have already developed kidney failure.

Senior Care: Preventative Care Is More Important Now Than Ever

October 21, 2009 By: Dr. K Category: General, Opinion

200467829-001Too often, as pets age, our mindsets change regarding how much financial and medical commitment we are willing to provide them. I hear all too frequently: “Well, he’s getting pretty old so I don’t want to run a bunch of tests. He certainly doesn’t need his vaccines and I don’t see the point in heartworm preventative.” While we can justify this line of thought, I challenge pet owners to approach their pet’s golden years from a different perspective.

Senior pets, just like senior citizens, require close monitoring to ensure their health does not fail prematurely. An old adage in veterinary medicine is that ‘Old Age is Not a Disease’.  Dogs are typically considered senior between 6-8 yrs of age with large breed dogs aging faster than small breeds. Cats are considered senior at 8 yrs of age.  Senior pets are more likely to develop common aging diseases such as heart disease, dental disease, osteoarthritis, thyroid disease, and early kidney disease. As pets age, their immune systems typically weaken preventing them from fighting infection as well as in the past. They slow down, spend a majority of their days sleeping, and sometimes struggle on cold days. They may develop a medical condition or two. But, with proper care, you can extend your pet’s quality of life by addressing these issues before they becoming life threatening. Below are a few ways you can stay on top of your senior pet’s health.

Twice Yearly Appointments

As you can imagine, an animal with a life expectancy of 12-14 years will age much more rapidly than a person with a life expectancy of 75-80yrs. Many health changes can be detected by your veterinarian based on your pet’s history and physical exam. At these appointments, do not be afraid to mention Fido’s difficulty getting up or Fifi’s ravenous appetite. Things you may think unimportant could signal disease to your veterinarian.

Senior Bloodwork

I cannot stress the importance of routine bloodwork enough. General health screen typically includes blood sugar, kidney and liver values, blood counts, thryoid values, and urinalysis. This bloodwork can detect sub-clinical disease processes like early kidney disease, mild thyroid disease, anemia, diabetes, among many others. This bloodwork is generally affordable and can prove invaluable if disease is detected early. Many diseases are treatable or manageable when detected early. A urinalysis can detect kidney disease before it is evident in bloodwork. Use a sealable plastic container to collect urine from your pet the morning of your appointment and take it along with you. Ask your veterinarian about screening bloodwork.

Vaccines and Preventatives

Vaccination protocol is not without controversy. There are several schools of thought concerning frequency of vaccinations in veterinary medicine, however, the vast majority of veterinarians agree that all pets should be vaccinated if their health allows. Senior pets are no exception. At minimum, all pets must be rabies vaccinated. This is the law. Even without the legal impetus, pet owners should ensure their senior pets are up to date on their rabies vaccine. A sad fact is that many animals will develop some degree of neurologic signs, from abnormal behavior to seizures, prior to their deaths. If your pet is not vaccinated for rabies, your veterinarian must consider the disease as she treats or euthanizes your pet. Rabies testing may be recommended. This is an avoidable scenario.

Heartworm and flea/tick preventatives are recommended irregardless of age. Discuss the remaining vaccinations and preventatives with your veterinarian to determine what protocol is best for your senior pet.

Follow Up!

If your sick senior pet sees the veterinarian, follow up! Stick with prescribed medications and, if financially feasible, pursue diagnostics. Call your veterinarian if you don’t understand the diagnosis or reason for testing. You and your veterinarian should work together to formulate a plan on how to extend your senior pet’s quality of life.

As pet’s age they rely on their owners to ensure a smooth transition from adult to senior life. Don’t undervalue the benefits of prompt and proactive care.

World Rabies Day

September 27, 2009 By: Dr. K Category: General

english-09-web-qualityRabies virus is my favorite zoonotic disease because it is a rule breaker. It kills its host in a rapid time period which, on a evolutionary level, is a poor method of propagating the virus. Because it affects behavior and is shed in saliva, it finds a way to spread quickly and effectively despite the host’s imminent death. The disease process is brilliant and highly effective. Rabies is a disease to be feared because it is uniformly fatal in people and animals infected with it.  Please join me in spreading the word on the importance of rabies vaccination in companion animals!

PRESS RELEASE: World Rabies Day

World Rabies Day 2009: Awareness is the Best Defense against Rabies

The world is again joining together on September 28th to raise awareness and understanding about the importance of rabies prevention. Rabies is the oldest and deadliest disease known to mankind and I im supporting this initiative.

Led by the Alliance for Rabies Control and supported by numerous human and animal health organizations worldwide, World Rabies Day is a unique campaign that brings together hundreds of thousands of people across the world to reinforce the message that rabies is a preventable disease, yet kills 55,000 people needlessly each year, half of which are children under the age of 151.

“Rabies is primarily a disease of children, who are particularly at risk from this terrible disease, due to their close contact with dogs, the major global source”, said Dr. Debbie Briggs, Executive Director of the Alliance for Rabies Control. “Children are more likely to suffer multiple bites and scratches to the face and head, both of which carry a higher risk of contracting rabies. Children are often unaware of the danger that dogs transmit rabies and may not tell their parents when a bite, lick, or scratch has occurred from an infected animal”, says Briggs.

Rabies is a viral disease that can be transmitted to animals and humans. The disease is transmitted mainly by bite, but exposure may also occur through contamination of broken skin or mucous membranes with saliva from an infected animal. Once neurological symptoms of the disease develop, rabies is fatal to both animals and humans. The good news is that rabies is easily preventable. “Vaccination prior to possible exposure is a crucial part of health management of domestic animals, and is the single most important factor in rabies prevention”, said Peter Costa, Global Communications Coordinator for the Alliance for Rabies Control.

Rabies prevention starts with the animal owner. Protect yourself, your pet and your community by taking animals to be vaccinated. Avoid stray animals and wildlife. If you are bitten, wash bite wounds with soap and water and seek medical attention immediately. If your pet is bitten, consult your veterinarian immediately. Prompt and appropriate treatment after being bitten and before the disease develops can stop rabies infection and/or prevent the disease in humans and animals.

The World Rabies Day initiative also raises money towards local rabies prevention and control programs, with eight projects funded since 2008. “Through the World Rabies Day campaign we continue to engage all the major stakeholders associated with rabies to take action”, says Costa. “We invite everyone to join the team that is Making Rabies History!”

More information on World Rabies Day can be found at the official web site, www.worldrabiesday.org.

1 WHO. Human and Animal Rabies, Rabies: A neglected zoonotic disease. Available at: http://www.who.int/rabies/en/. Accessed on July 23, 2008.

Video: Service Dogs and Canine Partners for Life

September 19, 2009 By: Dr. K Category: General, Opinion

Check out this video from Dr. Manny Alvarez, Managing Editor for foxnewshealth.com, about service dogs and Canine Partners for Life!

New Pet? Getting the Most Out of Your First Veterinary Visit

September 07, 2009 By: Dr. K Category: General

puppy_kittenMany new pet owners can walk out of their first veterinary appointment and wonder “What did the vet just tell me?” With talk of vaccines, deworming, flea and tick preventatives, food recommendations, crate training and more it is easy to feel overwhelmed. With a little preparation and use of the tips below, you can maximize your first appointments and ensure the health of your new furry friend.

1) Bring Your Paperwork…and a Stool Sample
Make sure you bring any paperwork you received when you purchased or adopted your new pet. This information typically contains your pet’s date of birth and vaccine/deworming history and is important in letting the veterinarian decide what vaccines are needed. Some pets come into your lives without any paperwork. If this is the case with your new pet, be prepared to start a vaccination schedule from scratch.

Bring a fecal sample to your first appointment. Nearly all puppies and kittens have gastrointestinal parasites like hookworms, roundworms, whipworms, and tapeworms. Roundworms are transmissible to people via fecal-oral contamination and hookworm larvae can penetrate a person’s skin. If your new pet is diagnosed with any of these parasites, your veterinarian will prescribe a deworming medication.

2) Write Down Your Questions

Some of the most prepared new pet owners come in with a list of questions on a pad of paper. Write down questions as you think of them and be sure to ask about every item on the list. Don’t be afraid to ask “silly” or “stupid” questions. Your vet has likely answered those questions in the past and can provide the reassurance you need to confidently raise your pet.  If you don’t ask, you’ll never know.

3) Don’t Try to Remember Everything

Your new pet will most likely require two or more appointments to ensure adequate vaccination. A good veterinarian will reiterate information provided in the first appointment during subsequent visits. And as I always tell my clients, it’s my job to remember your pet’s vaccination needs.

4) Schedule Your Next Appointment

Before you leave, schedule your next appointment. Even the best intentions can be thwarted by busy schedules, unseen events, and procrastination. To ensure your new furry friend is fully vaccinated, you need to adhere to the vaccine schedule laid out by your veterinarian. Lapses in vaccinations can result in development of serious illnesses or even death.

With information and a healthy foundation,  just relax and enjoy your new pet!

Garfield: The Secret

June 07, 2009 By: Dr. K Category: General

garfielddavinciOur favorite lasagna loving creation of cartoonist Jim Davis has a secret to tell. Garfield is a genetic anomaly. Garfield’s characteristic orange and black haircoat is his most defining feature. But did you know male cats with both orange and black in their haircoats are rare?

Here’s a little lesson in genetics: Females have two X chromosomes (XX) and males have one X and one Y chromosome (XY). The genes for a black haircoat and an orange haircoat are sex-linked meaning the genetic code for color is attached to the X chromosome. Black and orange cannot both occur on the same X chromosome. In order for a cat to display both orange and black in its coat, it must have two X chromosomes.

Calico and tortiseshell cats are nearly always female due to the sex-linked nature of coat color distribution. Instances where male cats have calico or tortiseshell coloration occur where there are chromasomal abnormalities.  An extra X chromosome in included in a male’s genetic code making him XXY, a condition called Klinefelter Syndrome. These males are typically infertile.

For more information about cat haircoat colors and genetics, visit this site!