Please Spay Your Dog

...when she is young....

...or you will end up with the scene above..a nasty rotting pus filled uterus that makes your dog sick and costs you more money. Is it worth it?

A Moment I'll Remember!

A little over a year ago, I attended a feline health continuing education seminar at Cornell University. During that seminar, one of the speakers/professors at the veterinary school, asked for volunteers for something going on the next day. It had to do with forming teams to do CPR on a "fake" kitty. I felt compelled. 


So, I, along with just a few others, got to be the first people in the world - yes, WORLD - to practice CPR in different "case" scenarios on a computerized type kitty. It looked like a stuffed cat but was hooked up to a computer. She had a "heartbeat", a "pulse" and "respirations." In addition, we could intubate her and have "venous access." Very cool. The different scenarios would be presented with history, signalment (age, breed, etc) and then signs and exam findings as well as the computer generated results of say, an EKG. 


This article talks about Dr. Fletcher's development of the robotic canine for CPR, etc. He developed that one first.


I'm just glad I overcame any fears I had about "performing" in front of my peers and volunteered! It was actually a lot of fun. My team saved our case from dying and I was instrumental in that!

Warning From a Vet About Ketamine Abuse in Humans

This is not something I'm hearing about as much as I was say, 10 years ago. But I'm sure there are people out there that will seek any drug high. Veterinary clinics have been and will be targets for break ins since we have all sorts of controlled substances on hand. Granted they should be locked in a DEA approved safe.


This vet in England took a video to show how quickly ketamine knocks a horse down. I've used it in cats and dogs and I can tell you that it does not look fun at all. We usually add diazepam to the mix so that it smooths out the muscle spasms, etc. But diazepam is more quickly metabolized so when they wake up, they can be in what we call a "dissociative" state - or the "ketamine crazies" - ie, a cat in a cage will have her head going back and forth and you imagine she's seeing 100 mice or 4 dogs staring at her. You go to touch her and she has a very exaggerated recoil reaction. Not something I'd personally want to abuse.


Check this out: Ketamine Warning

I Wish I Had Pictures

As I am sure you aware by now, I love to take pictures of cases I see in practice. They are fun and great for education. I've now gotten in the habit of doing it fairly routinely.  


I had a surgery that I wish I had pictures of but since I was the surgeon and it was pretty involved/intense, it didn't happen. I'm sure you understand the patient's well being comes before any thought of what would be cool for my blog. 


A young chocolate lab (lab being the key word here..number one consumer of things not meant to be eaten) came in a few weeks ago for vomiting. On her physical, another veterinarian felt what we both suspected to be an intussusception. This is where one part of the intestine telescopes into another part and can cause a partial or total obstruction.


Here's what it looks like:

This can be sliding or become adhered resulting in tissue damage/death.  


In our case, the dog was hospitalized on fluids and kept overnight. Blood work and radiographs of her abdomen were normal.  By the next morning it was gone. The dog was doing great and sent home on medications. 


What causes this? We often see it in young animals and most commonly it's anything that causes increased peristalsis or movement of the GI tract - such as parasites, dietary indiscretion, etc.  


This dog came back a week or more later. She was vomiting and losing weight. She was still a very active puppy.  When we palpated her again, we felt the intussusception. She was still so active and eating, we scheduled her for surgery after the weekend.


At that time, we thought we'd be going in to basically assess the area and likely resect the affected portion of intestine or tack the entire small intestine so that it wouldn't continue to recur. 


When I opened this dog up, I did find the intussusception in her lower small intestine. Amazingly, the tissue was healthy and it was easily undone. There were no adhesions or scar tissue present. But upon looking at the rest of her intestinal tract, it soon became clear she had a linear (string like) foreign body. Yes this was the cause of the intussusception.


I had to make an incision in 3 parts of her small intestine to get this string and the balled up wads of it out. I couldn't just pull it out of one area or I'd risk lacerating the already somewhat "angry" tissue. I felt something in her stomach but when I went in to find it, I couldn't. 


Still after closing up the other incisions, I re-ran the entire GI tract and sure enough there was a perforation where I could visibly see this string. She was on the verge of peritonitis. I attempted to pull out the string and the end that went up through the stomach would NOT budge. My boss, the vet that originally saw the case, was able to look in the mouth and found a loop of string wrapped at the base of the tongue - far back and cutting into it. She pulled it out from that way and it was a very long piece. 


Closing up the perforated area was tricky - the tissue would not hold suture well but resecting it was not an option at the time. Overall it was healthy, the dog had been under quite a while (in any dog but especially a puppy, I worry about hypothermia) and this area was right where the pancreas is located. I did not want to mess with that!   


So, we closed it all up, flushed her out and I prayed that her youth would work for her and she'd heal fast (with the help of some good antibiotics to cover her). 


We are nearly a week out and she is doing fabulous! 


This type of presentation is typical for cats - they eat string and often it gets caught under the tongue. That's why I always look under the tongue of a cat that comes in for vomiting. Dogs it's not usually they case. They may eat string or things that can become stringlike (towels, carpeting) but it doesn't typically hang up in the mouth like that. 


In any case, it was (shhh) fun to do. 

I've Never Seen One

It's always been MY standard policy to do a full physical exam before a procedure, notably a spay or neuter. 


When it comes to calico or tortoiseshell cats, this is sometimes overlooked. That's because this color pattern is sex linked in its inheritance pattern and almost (key word) all cats are exclusively female.  


I've always checked, though, hoping for a male cat. I have not found one but apparently there was one here:


Surprise!

Mushy Paw Pads in a Cat

A middle aged cat came in for lameness on one of her paws. This is what we found:

At first glance, you might think she burned her pad. These pads are often very "mushy" to the touch - not the normal semi firm consistency of a healthy pad. 


This condition is called pododermatitis. It can affect all the feet or just one or more. It generally affects the "large" pads on each foot or paw - the metacarpal pads (in the front paws) and the metatarsal pads (in the back paws). More specifically, this lesion is most often correctly called lymphocytic plasmacytic pododermatitis. That is a description based on a biopsy of these lesions. Lymphocytes and plasmacytes are the types of cells found in this lesion. 


Unfortunately, this is still a poorly understood condition. It seems to be similar to what we call eosinophilic granuloma complex (ECG), which can cause lesions on the upper lips ("rodent ulcers"), patches on the belly (eosinophilic plaques) or lines of inflammation that run down the hind legs in on the back surface (linear eosinophilic granulomas). 


They all seem to represent a type of heightened or over response of the cat's immune system. We know that in many cases of EGC, underlying allergies can be the cause (flea allergies, food allergies and inhalant allergies). 


Pododermatitis may or may not have a cause like this. Typically, one is not found and it's a matter of trying to resolve or remove the lesion. They are often treated with steroids - either oral or injectable, sometimes in the lesion itself. Antibiotics are also sometimes helpful. For refractory cases, the best course is to remove the pad. This seems to be a moderately painful problem for the cats as they are often lame. I have seen cats with all four feet affected. 


Fortunately, this is not a very common condition. 

I Don't Know What To Say

I have a few "topics" I thought about discussing that were inspired by some cases recently but today one of my last cases made such an impression, I'm using that as blog fodder today.


A middle-aged lab mix came in to have a skin problem evaluated. This has been going on for over a year. Another practice saw it, then another vet at this practice saw it and treated it differently. All of that was many months ago. In the meantime, the owner had changed the diet and got some meds "off the internet." Hm. Whatever they are.


The owner was also advised to seek the counsel of a veterinary dermatologist. This is not a bad idea in a case like hers. Skin problems are among the most common reasons us general practitioners see dogs. They are also among the most frustrating to treat. One reason is compliance, but another is that many of them are and will be chronic. It seems even when I tell owners this up front, they still don't "get it." They'll treat for a while and then stop or not have a follow up visit.  


This client told me she didn't want to see a veterinary dermatologist. I thought money would be the reason. That's fair and understandable. Yes, specialists do cost more. Her reason was not that. Her reason was that she felt they wouldn't solve the problem. Huh? But I can? I hope. If she hears what I am saying I guess.  Still, THEY deal with the worst, most unsolvable problems that us GP's cannot seem to fix or at least the owners hear the same thing from a $150/visit specialist so they actually do listen!


In any case, this dog has a condition that is chronic- a yeast infection of the skin. There can be underlying allergies but again, that can take a lot of time, money and diligence on the owner to figure out. Food allergies are complex. She has the pet on a "grain free" diet - a trend these days. However, all dogs are not simply wheat or corn sensitive. I've seen those that have issues with eggs, peas, pork, lamb, chicken, beef...get the picture? A true food trial involves a novel protein/carb diet for 8-12 weeks with NO..NO..No other treats/foods, etc. AND then you re-challange the dog with the old diet. THAT is a true diet trial.


The other component is inhalant allergies. We can blood test for these. This can be costly and will require injections if there are things the pet reacts to.


This dog needs to be on long term oral meds for her skin. And by long term, I mean life time. She will get weaned to a 2-3x/weekly dose at some point if the owners follow up properly.


Situations like this are frustrating for us too. We want to see these animals get better but it requires a TEAM effort.

Just Say NO..

..to any..ANY..edible (use the term loosely here) products made in China. I think that's a good idea for human and pet alike.


Here is another recall on a chicken jerky product that can affect your dog's kidneys.


http://www.foodsafetynews.com/2011/11/fda-repeats-warning-on-chicken-jerky-for-dogs/

Who Does This?

It's amazing the stuff you simply CANNOT make up.


Check this story out:


Children Exposed To Rabid Bat at Birthday Party

Something I Have NEVER "Seen"

A really nice older gentleman came in with a cat we hadn't seen in a few years. This cat is FIV + (I wrote about this feline specific virus in January).  


The owner has another cat and both of them are mostly indoors. He did say this cat had some outside time but not much and not far from home. In the past, this cat had an eye infection so he thought what he was seeing was a recurrence of that. This had been going on for almost a month (no I have no idea why he waited that long). I do not advise waiting that long with eye issues, as it can mean the difference between vision loss and sight and/or keeping the eye or needing to have it removed.


This is what I saw with this cat's eye:

The "cloudy" area you are seeing is not ON the cornea. It is behind it. The bottom picture shows it a little better. Any ideas? 


Another hint: when you shine light into it, you can see a "Y"


Here's a diagram that might help you:

It's the lens.  The lens is the oblong disc shown above hanging between the darker thick black lines (the iris or colored part of the eye.)


The lens luxated, or popped, forward into the anterior chamber. How does that happen? Not easily. This takes some trauma. A typical cat fight, even a good swat to the head, is not likely to cause this unless the other cat is a mountain lion. 


Usually we will see the lens luxate back into the posterior chamber. What we see then, as we look through the iris and into the pupil (or dark central part of eye) is a "half moon" in the back of the eye representing the lens, which will drop down a little. This type of injury is usually associated with a fall from a height or a auto vs pet situation. 


I have no idea how this happened and the owner has no historical comments that would help us. The bottom line is, the eye is comfortable, blind and there is nothing to do for it. 


We measured the intraocular pressures as a lens being in the front chamber may cause problems with fluid flow, resulting in glaucoma. Right now, kitty is fine. 

Sometimes There is No Substitute

Here's something that came up today. A client had a young German Shepherd (the most common breed that gets this disease) that was recently diagnosed with exocrine pancreatic insufficiency. This means that the dog's pancreas does not produce enough digestive enzymes for the dog to absorb the proper nutrients from her diet. Without treatment, the dog will have chronic diarrhea and continue to lose weight, as well as have other health issues secondary to malnutrition.


Fortunately, they can utilize pig pancreases to make a powder supplement we can give to dogs. This works extremely well.


In the case of this dog, she's gained weight, her coat looks great and there are no issues.


However, this is a not an inexpensive product. Why? It's not cheap to make. Utilizing animal organs and going through the process of purifying them and guaranteeing the proper levels of active enzymes are in EACH dosing costs a bit of money.  


The client that owns this dog came to me today with a product that he thought was "comparable." I was not familiar with it but figured I'd check into on a break. I went on line and found the ingredients, sources, etc. As it turns out, this product:


1. Lacks one of the KEY enzymes needed
2. Is not made from the very effective porcine pancreas but instead via fermentation involving fungi 
3. Does not have the vitamin support in the product we use (key because lack of ability to digest fats can lead to A,D and E deficiencies)
4. Is a nutraceutical (not an FDA approved drug) therefore, the  active ingredients are not regulated at all. It may have what it says or not. One batch may, the next not, etc. 
5. The 2 enzymes it does are MUCH lower in quantitative active units than the veterinary product.


Trust me, we want to buy the cheapest product WE can find too. Then we don't have to charge as much either. Sometimes, prevention or control of a disease, while seemingly costly, is actually cheaper than treating the myriad problems that go with going cheap or not treating.

Occupy Stupidity

As if the dogs involved weren't bad enough, now we have canines being affected too.


You gotta love these people. And who's tax dollars and donations are paying for someone else's poor decision, bad judgement and lack of proper veterinary care? Yeah, mine and likely yours.

Contagious dog illness spreads at Occupy SF camp

By: Max DeNike | 11/14/11 9:53 PM
Examiner Staff Writer

Dogs better watch their backs at the Occupy SF camp.

Three pooches residing at the Justin Herman Plaza space have tested positive for the highly contagious and deadly parvovirus, putting all four-legged friends there at risk, according to San Francisco Animal Care and Control.

Read more at the San Francisco Examiner: http://www.sfexaminer.com/local/2011/11/contagious-dog-illness-spreads-occupy-sf-camp#ixzz1dpduTg00

"Roux Brees"

I haven't blogged in a few days because I went away to see my family and to the Univ. of Delaware homecoming game (my undergrad alma mater). My parents do not have internet access and in fact, don't even own a computer. I know. I know. I've been working on them for a bit. I think they are starting to soften. But I was unable to find the time to go hang out a Starbucks (and if you know me, you know I could come up with some excuse pretty readily) to do any type of blogging.


By the way, UD beat Richmond 24-10. One more win against 'Nova and we MAY get into the playoffs (the REAL playoffs in college football). 


Anyhow, I found this cool story that ties into my vet school, Purdue University. This dolphin is named after a somewhat known NFL QB who helped Purdue get back on the map and took us to the Rose Bowl.


Check it Out!

Do You See the Thongs?

Aha! I got you with that one. I know, you came thinking you'd see a picture that was either "hot"  or disgusting. I don't post stuff like that on MY blog! (Well, ok some of the medical and surgical cases I post could be disgusting to some of you but you know what you got into when you started reading MY blog.)


What was I talking about though? Check this out:

This was an abdominal radiograph taken on a 2yr old German Shorthair Pointer that had been vomiting for several days. The dogs runs around on a lot of property but didn't eat "anything" according to the owners. This case is exactly why a foreign body is never off the list. Frankly many times people just don't know what the dog ate.


You can't "see" them on this film. What we see that is abnormal, though, is that the intestines are bunched up and the cranial (or left side to you viewing this - ie, toward the head of the dog) part of the abdomen has a loss of detail (raising a concern about a potential perforation and subsequent peritonitis). Basically, it doesn't "look right." 


Yes, there is a small metal object in this view too. Unfortunately, because of how busy the day was when this case came in, I don't have any intra-op pictures. I know - I too, was disappointed! 


The intestines were bunched up as they get with what we call a "linear foreign body" - ie, string like objects. A small amount of material was removed from an incision into the small intestine (enterotomy) but the major stuff was in the stomach - 2 thongs apparently.  The metal thing was something unrelated. 


I wonder who they belonged to....


(no, I don't have an answer because I admitted the dog and my boss was the one in surgery that day so she is the one who spoke to the owners post op - but tomorrow I WILL ask)

Don't Mess with Porcupines

A nice young lady took her dog out for a trail walk on this beautiful day. Her dog got a way from her but still in sight. Then he returns to her looking like this:

This dog TRIED to eat a porcupine. Well, believe it or not, this is a small number of quills. Most dogs end up with hundreds!


Fortunately this is an easy but sometimes, time-consuming, fix. We need to sedate the dog and then back these out or sometimes cut  the end off because like fish hooks, they have barbs that often prevent us from simply pulling them out. 


This dog went home no worse for wear in under an hour!

Sweet!

An easy way to make the vet staff happy before your pet's surgery (though trust me, not a requirement for a well executed procedure and successful outcome) is to bring something delicious in for us to eat!


Today we had an older dog in for a growth removal. This dog has some health issues (kidney and liver - yeah it doesn't get too much more major that than) and he knows the dog is at the end of his life span. But the growth was bleeding and the dog is still happy, so he elected to have this growth off AND even to have us send it out to the pathologist. What a great pet owner. 


BUT, he also brought us these absolutely-deliciously-worth-every-calorie concoctions called "horsehoes" from some local place. O. M. G. Let me tell you, they were made with phyllo dough and had powdered sugar - almost looked like funnel cake but they were solid. Inside was a cheese cake like filling - not quite as rich and not too sweet either. Yeah. 


Just know, in general, that your pet's veterinary office will always be happy to get food especially from a great bakery, a good lunch place, and even homemade (but caveat here..many of us are thrilled with this..but are selective about who we'd eat it from).

World's Wackiest X-Rays

I always enjoy the radiographs of dogs/cats and other critters that swallow or eat some bizarre things. It never ceases to amaze me what we'll find inside an animal. Many times, food has nothing to do with it.


Check this article out with the cool x-ray pics:  Weird X-rays

I WANT This Cat!

I have a thing for polydactyls, what can I say?


26 toes..he's freakin adorable. I just want to kiss those cute mitten feet!  I am glad he's helping raise funds for the shelter though. 


Check It Out

Who Wants to Meet This Guy?

...in a dark alley? 


Ugh. This disgusts me. 4 months in jail and gee, he can't have a dog? Wow. What do you think someone who does THIS is capable of? Do ya think he may hurt humans at some point? Hmm...




Man Stabs Dog 29 Times

Go With Your Gut

I saw a dog yesterday that had vague signs: not eating well and lethargic. This can mean a lot of things of course. Well, the dog was 10 yrs old so that does tend to make us focus on certain things - most of which are not good.


This dog's exam was pretty normal except she had a fever. We pulled some blood work on her to go out to the lab. That would be back in 24 hours. 


Still..in the back of my mind, I thought "x-ray this dog's abdomen." I didn't though. Her abdomen was rounded a bit but she was tense and difficult to palpate. Still, you can never go wrong with a chest and abdominal x-ray on any patient, especially an older one.


AND she had a fever and lethargy so I was more curious about the blood work - she had no signs of an upper respiratory or some other obvious source of infection.


Her blood work came back today and it was VERY abnormal. Her red blood cell count was low and her white blood cell count was very high. The lab did an internal review (which they only do when things are "odd") and found she had a regenerative anemia which means her body was losing blood but responding appropriately by producing more red blood cells. The biggest concern I had (that little voice in my head yesterday said it too) was a bleeding mass in her abdomen. 


I called the owner right away and had her come in for x-rays. Sure enough, there was a LARGE mass, which was likely her spleen and some free blood in her abdomen. Her chest x-ray was clear which is good. That doesn't mean this isn't malignant but at this point, it hasn't spread to the chest (the most common place it does this.)


So, the only way to deal with that is surgery. This is what my boss saw when she opened her up:

There were adhesions all over the place. This mass was the spleen but fortunately other organs looked fine! She sent out a few pieces to the pathology lab. That's the only way we will know if this is cancerous or not. 


For now though, we definitely saved the dog's life and bought her some time!

Icky Mouth

Traditionally mouths this bad are reserved for dogs. 


This 18 yr old cat was seen by my colleague/boss for mouth odor. The pet had been cared for by another family member before the current one took over recently. 


This cat, as seen in the first photo, had a huge pocket/opening that went WAAAY up under the gum on the upper left side. Even with really bad teeth, this doesn't usually happen. Also, the hard palate was missing some tissue on the other side of the teeth (the lingual side - side that faces the tongue).  There is a chance this is not simply a case of a severe dental and bone infection. Cancer, or neoplasia, may be involved as well. Only time will tell. The offending teeth (most of them) were removed, the cat remains on antibiotics, and we will recheck this cat in a few weeks.