What Will It Turn Out To Be?

A few months ago, I discussed a case where a pet owner thought their dog "tore a toe nail off" and that's why his foot was bleeding. Early into the exam, I knew this was NOT the problem.

It was clear this 12 yr old mixed large breed dog most likely had a cancerous growth of the toe. The only potential cure would be to amputate that digit (the dog would be fine without this toe). I say potential because there are some types of growths that have a higher potential to spread (or metastasize) to other parts of the body. We just won't know until the pathology report comes back what we are dealing with here.

The dog finally came in for surgery today and this is a post op pic of the foot - minus one toe! 

It will probably take more than a week to get the pathology results back. I will post the final "answer" when I get it!

No Kill Lehigh Valley Needs A Few Things

I received this email and wanted to pass it on (mainly to my local readers) in case anyone could help out.

We are always coming up with new ideas for crafting things to sell at our events so we can earn money to help more animals. We NEVER EVER use any of our NKLV funds or donated money for this and our volunteers & board members always use our own money to do these things. In keeping with the committment to use ALL money directly for animal care it does get hard sometimes to keep doing this so..... we are asking around to see if anyone has any connections or can donate any of the following items:

Dawn dishwashing liquid

vinegar, glycerin

100% cotton fabric

dried catnip

craft pillows (the kind you make your own covers for)

those fuzzy throws you can usually find in drugstores for a few bucks

ink for cannon pixma printer

white t-shirt transfers

wool for knitting color doesn't matter

printer paper

card stock printer paper

Cat/dog toys or treats

 felt christmas stockings

If you can help with any of this or have any connections to this, please let me know at ramona29@rcn.com and thank you!!!

Ramona

Dog Flu Season?

I don't think there really is a "season" to the dog flu. Canine influenza, H3N8, is a highly contagious viral disease, like our own versions of human influenza. However, it seems to pop up sporadically in "outbreaks" throughout the year. It is highly contagious and spread by respiratory secretions, including from dogs who are apparently healthy.


There is a very good vaccine for this disease that we in the veterinary field term a "lifestyle" vaccine. If your dog literally NEVER leaves your house, you probably don't need to worry about it. However, you can even get it at (dare I say it) your vet's office. Sure, if someone brings a sick patient in, they could be spreading viral particles throughout the air. Do NOT use that as an excuse to avoid regular veterinary visits. Trust me, we go out of our way to isolate these patients and keep them away from healthy animals. However, the point is, if your pet goes to a groomer, a daycare, a dog park and other such places, they are at risk.  


Since most dogs do NOT have natural immunity to this virus, they can be at risk of serious infection. Signs include lethargy, fever and nasal discharge. This can be a fatal disease, especially if leads to pneumonia, so it is not something to take lightly. 


Is there harm in vaccinating? Not in my opinion or experience. Any vaccine can cause a vaccine reaction. I have NOT seen this with this particular vaccine. I vaccinate my own dog, annually (as per the recommendation), against this disease.


Canine influenza is NOT transmissible to other species!

Fun at the Fun Dog Show

Someone I respect and cherish recently commented to me that last week's posts were a bit depressing. I don't look at the week as a whole like that too much. Each day is so totally different than then next when you are in veterinary medicine. However, I will be a bit more aware and try to intersperse the sad stuff with some good things too. It seems the sad stuff is where we and you can learn the most.  

In any case, today I went to an event called Melon's Gift Fun Dog Show. It is an event that has gone on for the past 7 years and was inspired by one lady's survival of breast cancer, her dog and her wish to do good with her time.  This is a fundraising event for breast and other cancers. And it's a ton of fun. A great day out for the dogs too. There are all sorts of cool categories such as: 

	Dog with the wiggliest butt
	Dog with the most expressive eyes
	Dog most in need of a bib
	Dog/owner look alike
	Fancy Dress
	Dog with the most expressive ears
	Best smile
	Best kisser I went along with my dog and my boss's dog and we just had a nice day out. Of course, it was a bit humid but the social time was good for human and canine alike! Amazingly, though there were dogs of all sizes, ages and breeds, everyone got along great...hmm..a lesson we humans could learn, right?

Veterinary Liability

I decided, after reading one of my AVMA Liability reports that I receive in the mail every few months, to share some of these stories with you. Then you can get a better idea of why we do what we do and how ridiculous some people can be. 


This is taken directly from the most recent report and is a "closed claim." Sometime they publish open claims as well. 


Dr. A was presented with a cat for an exam and vaccines. The owner assisted the technician with weighing the cat. When the cat stepped off the scale, it stepped in the wrong direction, and the owner reached out to redirect it. The cat reacted and bit and scratched the owner's hand.  A technician cleaned and wrapped the wound, and Dr. A advised the owner to seek medical attention.


The owner elected not to continue with the exam and left with the cat. The owner's hand became infected within 24 hours, and the infection was slow to respond to treatment. The owner called Dr. A and demanded reimbursement for out-of-pocket medical expenses. Dr. A reported the claim and consented to settle the case. After a claim review, the PLIT-sponsored insurance carrier determined that it was below the standard of care to let the owner assist with handling the cat during the examination and contacted the owner to discuss a settlement.


The owner needed medical attention for six weeks, which included multiple specialist visits as well as several emergency room visits and home nursing care. The owner's health insurance carrier also pursued subrogation against Dr. A to recoup the medical expenses, because the owner was not at fault for the injury. Dr. A's insurance carrier prepared for a settlement offer that included lost wages and medical expenses. The owner accepted the settlement offer, and Dr. A's insurance carrier paid $22,760 to the owner. The owner's insurance carrier closed the malpractice and subrogation claims.


What can we learn from this?
1. Cat bites are always serious and anyone who receives one - even if it's NOT at your vet's office, should seek immediate medical attention. I've never advised anyone otherwise. If they chose not to, that's on them, as I have documented it in the record.
2. There is a very good reason why we try our best (and yes, there ARE cases where the owner holding does help) to limit restraint to staff (techs and docs). Unfortunately, you cannot assume someone will not sue you.  And remember, no matter what the owner says, its pretty clear that the fault will always be on the veterinarian in cases like this.  

Flea Season

The past few weeks, I have seen flea cases nearly once to multiple times a day. This is the height of flea season. The wetter it is, the happier they seem. In reality, though, the problem lies in how persistent the little buggers are in the environment.

Cat flea life cycle

The flea egg can survive in the environment for a long time - months and more. This is why someone can rent an apartment or home that's been vacant for a time and suddenly find their pet has fleas. Fleas sense the carbon dioxide we exhale and the humidity that living beings bring into the environment.  


The can also lay a tremendous number of eggs, causing an infestation in a short time. The other thing to note is that the live fleas seen on your pet represent only 5% of total flea population in the environment..so one flea CAN mean a big problem.

Fleas are easy to prevent with some excellent, safe products. I personally recommend Revolution for cats and Vectra for dogs. For pets that are infested with live fleas, Capstar works for 24 hours to kill any live fleas and help bring some immediate relief. This tablet CAN be given once a day for a long time but there is also a product called Comfortis that works the same way. ALL pets in the household must be treated for this to be a successful elimination of these pests.


 It is also critical to treat the environment. Bombs are not recommended as fleas prefer dark environments (ie, under the furniture). Bombs lay a mist on horizontal surfaces. Sprays and simple vacuuming/washing of bedding, etc, work best. 


The interesting thing is that very often we find fleas or flea dirt (flea feces = digested blood) on "indoor only" pets including cats that live alone. This is why it is critical for veterinarians to flea comb EVERY patient that comes in to the office. 


Fleas can and do carry some nasty organisms that cause disease, some of which are zoonotic (think "cat scratch fever") and in many animals their saliva induces an allergic reaction, resulting in intense itching and secondary bacterial infections (called Flea Allergy Dermatitis - or FAD).


If you keep your pet on a monthly, YEAR round preventative, you are much less likely to encounter this as a major problem. Year round is key - the weather and conditions vary so much from year to year. Missing one month can make a difference.

Rare Turtle Gets CT Scan

In case you can't tell by some of the articles I find, I MISS zoo work so much!!!

Modern medicine for an ancient species

Angela Carella, Staff Writer

Updated 04:04 p.m., Thursday, September 22, 2011

In Stamford Wednesday, a prehistoric animal got a CT scan.

It was something to get your mind around.

Arizona, a Galapagos tortoise, has not been using his right hind leg, so his owners and veterinarian brought him to Cornell University Veterinary Specialists, which opened on Canal Street in January.

There, the 300-pound Arizona, whose species walked the earth with dinosaurs millions of years ago, was sedated and wearing an oxygen mask. A monitor beeped his heart rate, and the red crossbeams of a laser shined on his shell as a technician positioned the state-of-the-art scanner.

Arizona lay on the table that slid him toward the imaging tube but his shell, nearly 4 feet long, was too big to fit inside. So veterinarians and technicians backed him up to it and extended his injured leg for x-raying.

Read more: http://www.newstimes.com/local/article/Modern-medicine-for-an-ancient-species-2182574.php#ixzz1YiyEe3Rj



There are some nice pictures on this site too! Check it out!!!

Sometimes It's Simply Too Late

Today I had a 20 year old cat brought in for a second opinion. The new client had been to a local emergency practice over the weekend because his cat was having difficulty breathing. After an exam was performed, they recommended euthanizing the cat. I do not know what was discussed as I did not have the records. The client didn't want to do that, so came to me today with a cat that was, just in the exam room, obviously TRYING to die. He was clearly having very labored breathing that was more than just the "stress" the client blamed it on. 


I told him that we should get an xray to see what was going on but that even the stress of that could put a cat in this condition over the edge. Sure enough, carrying the cat to the xray area did just that and we had to put him on oxygen and perform CPR. We were able to get a quick radiograph, seen below:

What do you see here? Or maybe I should say, what DON'T you see? Correct answers: 1. air filled lungs 2. cardiac silhouette (or the heart).


Below is what a normal cat chest should look like:

So what was in this cat's chest?

A blood tinged fluid. 


So despite our attempts at resuscitation, this cat did not survive. 


He very likely had neoplasia (cancer) of some type or form. He very likely had this brewing for a while but the owner missed subtle signs. 


This is why we recommend that our senior pets be brought in twice a year for exams and blood test. This cat had been losing weight for a time of unknown origin. We couldn't have cured this but we could've possibly prolonged his life and given him more quality at the end. 

A No Win Situation

This is one of those things that just gets to me. We had a kitten brought in by a good Samaritan on Friday. This little kitten had a severely infected eye that was beyond fixing. It needed to come out soon. I, generally, prefer to wait until a kitten this young gets a little more weight on him. However, this infection was so bad, I was concerned about this affecting the kitten's overall health.  I made the decision to go ahead with surgery today, but was concerned about a patient this small becoming hypothermic (too cold) and handling the anesthesia, even for a short period of time. 


Unfortunately this kitten passed away just as I was about to start surgery. He went into respiratory arrest and was gone before I could do much. 


I felt terrible but had I waited - and how long would it be before he was substantially bigger?  likely weeks - this infected eye could've caused other problems.  I couldn't leave it for that long but having gone ahead makes me wonder...Still, that's part of making decisions in medicine = they don't always turn out the way you expect or hope.

Not A Good Find

An 15 yr old came in for a dental cleaning and removal of at least one tooth. She was having some difficulty eating and the vet that saw her noted a problem with one of her molars. 


When the nurse anesthetized and intubated this cat, she found something else:

This was a very deep ulcerative lesion on the top of the tongue. It was too far back to be seen during a routine exam. It did not look "good" so I took a few biopsies of it. And it came back as Squamous Cell Carcinoma. AND there is no good way to address this as removal would involve removing the tongue..yeah, NOT an option. The cat is older so the owner does not wish to seek radiation treatment, which some of these tumors do respond to. Understandably, he's keeping the cat comfortable until it's time.  

Cheetah Gets a Root Canal

This is yet another cool story! I actually visited this zoo and its veterinary hospital when I was in California a few years ago. We had gone to a veterinary conference in Las Vegas and took a few extra days to visit some very good friends that live approximately 1 1/2hrs from LV in the high desert of southern CA. My friends, knowing I'd always be game for seeing animals, took us to The Living Desert. This veterinary hospital is very impressive. Trust me. I would've very gladly worked there (well, except I didn't want to live in California)! 


This story has a short but very well done video showing the cheetah under anesthesia and how the public can view all sorts of procedures. 
-----------------------------------------------------------------------------

Thirteen-year-old cheetah gets root canal at valley zoo

 Written by Sherry Barkas The Desert Sun

Palm Desert — Nobody likes to have a root canal, but if you're a cheetah, you at least get to sleep through the procedure.

Topaz, a 13-year-old cheetah at The Living Desert, started her day Thursday with a trip to the dentist.


Stretched out on a gurney in a glass enclosed surgery room at the zoo's Tennity Wildlife Hospital and Conservation Center, the anesthetized 90-pound cat was oblivious to the team of about six doctors and technicians working on it.


There was no twitching of the paws as devices attached to them to monitor her heart and other vitals were adjusted. No ear fluttered as they moved her head from side to side to X-ray the cheetah's mouth


Cheetah Gets Root Canal

Another Dolphin Story - This One Happy!

I apologize for going to another news story for my blog today but I admit to being overwhelmed this week with the Healthcare Event coming up Saturday that I've advertised on my blog a few times. 


This story caught me by surprise too though, as I've never heard a dolphin with a prosthesis before! Very cool!

Art imitates life in 'Dolphin Tale'

By MITCH STACY, Associated Press – 2 days ago  

CLEARWATER, Fla. (AP) — The little injured dolphin they called Winter couldn't have come along at a better time for the Clearwater Marine Aquarium, a rustic sea life rescue center occupying the city's old sewage treatment plant.

The nonprofit public aquarium was about ready to go belly-up at the end of 2005 when the baby bottlenose dolphin was brought there after getting her tail tightly entangled in a crab-trap line. She lived, but her tail fluke withered away, forcing the young animal to learn how to swim with just a stump and then adapt to a revolutionary prosthetic. Winter's inspirational story of perseverance made her a global media star, quadrupled attendance at the aquarium and spawned a lucrative line of toys, books and other merchandise.

Now Winter is a movie star.

The charismatic animal plays herself in "Dolphin Tale," a family-friendly 3-D movie starring Harry Connick Jr., Morgan Freeman, Ashley Judd and Kris Kristofferson, opening Sept. 23. The production is based on Winter's unlikely story of surviving the loss of her tail, then thriving and inspiring human visitors — including war veterans — who have lost limbs and are adapting to their own prosthetics.

The story got some fictional tweaks — a troubled boy (Nathan Gamble) who bonds with Winter was created as a central character who finds the gravely injured animal — but the movie sticks close to the real events surrounding the loss of Winter's tail and her recovery at the aquarium. And in another twist on art imitating life, in the movie Winter's presence helps save the modest marine rescue center from financial ruin. A big chunk of the film was shot at the facility last fall.

"Largely what you see with her rescue, her rehabilitation, the (prosthetic) tail being made, the fact it was filmed here and Winter stars as herself, it's pretty much real life," aquarium CEO David Yates says.

Connick, who plays a veterinarian and director of the marine rescue hospital, says he didn't find out the script was based on a true story until after he had read it.

"I thought it was somebody's creative imagination at work," he says. "I was just blown away. I couldn't get over it, really, not only because of her survival and consequently thriving, but the advancements they made in human prosthetics because of it. I was just blown away that the whole thing was true."

The Rest of the Story AND Some Cute PIctures!

Sounds Reasonable to Me

I'm sometimes amazed at how much people get caught up in the minutae of things. One would think a service dog (and there are multiple types of service dogs) would be allowed nearly anywhere, especially in a facility that serves veterans. Well, hopefully NOW that will be the case. Who knew we needed a new law to state that?

Bill approved to make VA service-dog friendly

By Rick Maze - Staff writer
Posted : Monday Sep 12, 2011 16:55:07 EDT

The House of Representatives could vote as early as next week on sweeping legislation that makes the Veterans Affairs Department more dog-friendly.

A House committee has approved legislation that would allow service dogs to be used on any VA property or in any VA facility, including any facility or property receiving VA funding.

“I’m really pleased this legislation is moving, just for the sheer fact we have been trying to do this for so long,” said Christina Roof, deputy national legislative director for the veterans’ service organization AmVets. “VA could have done this itself, by regulation, a long time ago if they wanted, but they haven’t done anything so it looks like Congress will.”

Under current law and regulation, VA is required only to allow guide dogs for the blind onto its property and into facilities because those are the only type of assistance animals specifically covered in federal law. Individual facilities directors can be more flexible, if they wish.

VA officials have been working since March on trying to come up with a new service dog policy but discussions have been bogged down, in part, over the question of whether the policy should specifically list the types of service dogs that should be allowed or to leave that open to interpretation.

Language included in HR 2074, a veterans’ health care bill passed Sept. 28 by the House Veterans’ Affairs Committee, would end the discussion. The provision is very direct, saying the VA secretary “may not prohibit the use of service dogs in any facility or on any property.” The bill makes no effort to define what constitutes a service dog.

Roof said she expects common sense would be used, with eligible dogs having received some specialized training in order to be considered a service dog and with facilities still able to have restrictions on where dogs could go on the premises. For example, a service dog would not be allowed into an operating room but might be allowed in the waiting room of a medical clinic, she said.

In addition to opening the buildings and grounds to service dogs, the bill would create a three-year pilot program in which veterans with post-traumatic stress or other post-deployment mental disorders would be involved in training service dogs for other veterans. The idea of the test is to see if being a dog trainer has any rehabilitation benefits for veterans.

Veterans who have service dogs would have priority in being hired as trainers under the pilot program.

Source

A Post 9/11 Story

I try to do stories on special days or holidays that reflect those days or relate to them in some way. I didn't have one for yesterday, 9/11. 


I found one today that I liked about a vet practice that was near Ground Zero but stayed open and is now doing great!




Four Small Business Owners Who Stayed Put After 9/11




September 10, 2011 10:36am | By Julie Shapiro, DNAinfo Reporter/Producer

LOWER MANHATTAN — By the summer of 2001, business was finally picking up at the Battery Park Veterinary Hospital.

Veterinarian Mark Burns had opened the practice in early 2000 after noticing more residents — and more pets — on the previously underpopulated streets of the neighborhood. The practice grew slowly at first, but by its second year it had a roster of regular clients, many who already knew Burns from his TriBeCa and West Village locations.

Then, on Sept. 11, the World Trade Center collapsed four blocks away.

Dust and ash filled the South End Avenue clinic. The fires at Ground Zero burned for months, infusing the air with a penetrating stench. Clients and their pets moved away, and new ones did not replace them.

"I probably should have closed the practice," Burns, 64, said recently. "There were not enough people left. But I didn't."

While many Downtown businesses shut their doors for good after 9/11, hundreds more managed to survive, or even flourish. And each year, dozens of new businesses have opened, seeing opportunity where some saw only destruction.

Burns reopened the Battery Park Veterinary Hospital in early October 2001, after cleaning out the small 800-square-foot space and replacing thousands of dollars of refrigerated vaccines and medications he lost when the power went out.

"I had people tell me I was crazy," said Burns, who lives in Stamford with his wife and three children. "But we're committed to our clients and our pets. I believed in the long run, everything [would] be fine."

The quiet practice hobbled along for the next few years, supported by income from the West Village and TriBeCa locations, until, in the spring of 2004, the clientele finally reached pre-9/11 levels.

Since then, the neighborhood has added thousands of new residents, increasing demand so much that Burns is now planning to open a fourth location later this year in Southbridge Towers.

"The alternative is unthinkable," Burns said when asked why he kept his business in lower Manhattan. "We're established here. We have people who depend on us."

Ten years after 9/11, Burns still clearly remembers watching with horror as the attacks unfolded on his TV, then wrangling his way into a smoking lower Manhattan at 4 a.m. Sept. 12 to ensure that all the animals under his care were safe.

He also remembers a moment three weeks later, when several firefighters entered his office carrying a tiny white kitten they had found in the rubble at Ground Zero.

Burns realized the kitten must have been born within a few days of 9/11. He named her Zero and decided to bring her home. This week, Zero will celebrate her 10th birthday.

Read About the Other 3 Businesses Here

Things Heard In Public

Sometimes when I am out, I overhear things that people say about animals, vets, things they think they know about medical care of people and pets, etc.  Many times, these people don't realize that the person in earshot or even in the conversation is a veterinarian.


This should serve as a reminder - as it often does to me - that you never know who is around you when you are talking - so be careful with your words! 


There are times, though, when people know what I do for a living and tell me things that make me cringe. One of my biggest jobs as a veterinarian is educating clients. However, when I am out and hear some of these things, I have to bite my tongue at times. I've heard some ridiculous things and also things that make me want to tell people to seek another vet. I have to be careful what I say and how I say it. I do get rather tired of Dr. Internet popping up as the answer (instead of them calling a veterinarian first). 


Here are a few examples of things I've recently heard:


1. When discussing a no-kill shelter and the fact that they keep animals that are suffering horribly - alive (um..generally not true - even NO KILL, does euthanize!) - "they are so full of worms it's a shame"  - worms?? Intestinal parasites are so common! I know many of YOUR well loved pets have them. They pick them up all the time outside - cats that hunt, dogs that go out back and pick up everything - and they are generally not serious and very easy to treat! (note: if your pet is on monthly, year round heartworm prevention YOU are a step ahead as these prevent/treat many of the common ones!)


2. "My vet will sometimes scrape my dog's teeth in the exam room." WRONG. Scraping teeth without polishing is BAD. You are putting grooves in the teeth, giving greater surface area for plaque and tartar to accumulate! The only proper dental for a PET is done under general anesthesia. On this one, I actually had to say it. Their vet is a waaaays away though. But really..come on now..he's older but that's no excuse.


3. From an on line dog group: someone complained about the stain their dog's vomit was leaving - the yellow bile that comes up sometimes. Someone else - NOT a vet - said this was a sign of pancreatitis. WHAT?? No, no and no. Vomiting bile is not a sign of anything but whatever is causing the vomiting - of which, pancreatitis is one of about 75 things. Where do people get this info?  I know, the great internet. OR their dog vomited and was eventually diagnosed with pancreatitis so they linked the two. 


All I can say is that the more I hear this stuff, the more I realize how much work I have ahead of me.