Not Much To Say

Today took it out of me, I admit. It was fairly busy and not necessarily crazy but I did have 3 (and almost 4) euthanasias today. So forgive me for this very brief blog today.


One thing that struck me today. As soon as I heard it, I thought "this is going in the blog." In fact, it might BE the blog.


A client with a very ill kitty that hadn't seen a vet in years was in and was one of those 3 I mentioned. The cat had oral cancer. It was in bad shape. This cat has a sibling kitty. I tried to impress upon the owner the importance of regular check ups as there are many diseases where we can prevent or slow down progression. Her initial comment was that it was an "indoor cat." 


Oh sigh. This is one of the biggest notions  out there that keeps kitties from my door and from a better, longer life. That somehow indoor cats don't need vet care. Yeah, they do. They get dental disease, heart issues, weight issues, skin problems, growths, kidney disease, diabetes, urinary tract infections and the list goes on...


That wasn't even it though. The blog fodder.


She had told me earlier about the great lengths she went to make her grandchildren's pet hamster into a mummy (yes for real) and then even designed a really nice "Egyptian" box out of a small cigar box. Ok. 


We were discussing how some people put their pet's ashes into their family members casket or their own. She said "Oh I'd do that with my dog, but not my cat."


And there it was. The same old thing I am weary and heartbroken over. Cat owners that don't even love their own cats as much as their dog. It reminds me of family members I know that always loved, favored and treated the boys in the family much better than the girls. Incidentally, guess who was better behaved? Yeah, exactly. 


Please don't say stuff like that to me. How do you know that I am not the BIGGEST cat lover in the world? Or that maybe my mom just passed away (she didn't) and wanted her cat in there with her. Please use some discretion when telling your vet how much you don't like x, hate y or want to shoot _______. Trust me, yeah I've heard stuff like that..IN my office.

Update

Sorry I don't have a picture to go along with this but it was a busy morning of sick critters. 


This morning I saw our yellow cat from last week. He is doing well but he lost a little weight (this concerns me) and is still pretty darn yellow (eh, it can take time to get better but...). His owner reports he is eating well and frequently and he is getting his medication with no trouble. This cat loves dry and canned food but the owner had held off on offering dry food. I guess he was concerned about his surgery site healing ok. No worries. I told him offer him all of his favorite foods and a lot of it. He needs calories. We also gave him a prescription nutrient dense recovery diet to feed this week too.  He is reportedly more active and otherwise ok.


I will see him next Monday to have his sutures removed, an overall recheck and to repeat some blood work on him.


Fingers crossed. Prayers said. 

A Real "Ripple" Effect!

All I can say is, ya gotta love kitties! They always try to find ways to get where they want, when they want, no matter what! I refer to them as nature's little hedonists. Stubborn little hedonists. Determined stubborn little heodonists. No wonder why I admire them so!


Check out what THIS cat did!

The Beagle Brigade!

I'm sure many people aren't aware that the USDA-APHIS (Animal and Plant Health Inspection Service) uses beagles to help sniff plant and animal products coming into our country across borders and at airports.


You may wonder why this is necessary. There are many foreign animal and plant diseases that could harm and even decimate certain sectors of our agricultural economy. Some of these things could even potentially harm human health.

Here's a story about the beagles.

Not Sure How I Feel About This

I'm of the mind that, in many things but especially medicine, just because we can do something, we should not necessarily do it.


This stems from my clinical rotations through ICU my fourth year of veterinary school, where I saw animals that were being kept alive and going but were not going to return home or if they did, not with a very good quality of life. I am thrilled to find pet owners who will spend money and do whatever it takes to keep their pet healthy. There are things that do cost a lot and take a lot of commitment, but are absolutely worth it, in my opinion.  


This story talks about a knee replacement in a cat. If you know me, you know I am as passionate about cats as one can get. I never tire of seeing dedicated cat owners. However, as the owner of a very happy 3 legged cat, I can tell you that they live just fine with 3 legs. It's not about the money. What do you want to put your pet through when there's a very good alternative? In fact, this may not eliminate pain and there may be secondary issues post implantation.


I'm not here to judge. I am just thinking of how I personally feel on it and what I would do were it my cat. At the end of the day, we each have the right to make the decisions we feel are best for our pets and frankly, I prefer to keep it that way.  You cannot legislate morality. 

The Feline Conclusion

Ok, so I have you on the edge of your seats right? 


Well, here's what happened to our sweet cat:


This cat went home from the vet that he saw in mid-December. He was given an antibiotic injection because his owner could not pay for surgery and did not qualify for standard veterinary credit. 


The owner, after talking to some friends, decided to try peanut butter to help pass whatever was causing the problem. The cat vomited up 2 whole mice per the owner's report.


The cat continued to decline until I saw him last week. He had lost 3 lbs (major, HUGE percentage!) I found him to be very jaundiced and palpated a foreign body in his cranial abdomen. I told the owner the bottom line - the cat has a poor prognosis no matter what. Without surgery, he will die. With surgery, he  may still die. 


The owner clearly loved this cat very much and after talking to family found some funds.


We admitted kitty and did some baseline tests to make sure there were no underlying issues (feline leukemia/feline AIDS, a complete blood cell count, chemistry panel and a repeat x-ray). 


All things were pretty decent except for his liver values (not too bad) and his bilirubin (pretty darn high and indicative of gall bladder/liver issues).  The x-ray revealed his stomach to be full of something! 


So, after rehydrating him, we took him to surgery:

I spent a lot of time pulling out hundreds of wads of what I can only describe like "hair brush bristle" feeling objects. The stomach was FULL. No room for food or mice. Amazingly, the stomach lining was intact and there were NO perforations and THE rest of the intestines were NORMAL!

The bag of "goodies" that turned out to be.....part of a fake evergreen centerpiece Christmas display!

An upclose of these "barbed" plastic like things.
So after removing all these things. flushing out the stomach and checking everything out, I closed him up. He began eating well for us the next day! I will let you know how he does as I see him next week for a post-op check up!
 

The Yellow Kitty: Part 3

Today the sweet little slightly less yellow kitty went home. He is on his way to recovery but until he's gained some weight and isn't yellow anymore, I won't say we've achieved victory!


So back to yesterday. I asked several questions and here are the answers (they may not be all inclusive but they represent the top things that come to my mind and in my experience).


1. What are the possible causes of his signs (anorexia, vomiting, lethargy) and exam findings (jaundice, weight loss)?
-infectious diseases - a whole lot of those - some of which can affect the liver directly or indirectly
-hepatic lipidosis - aka "fatty liver" syndrome = the body breaks down fat for energy, this fat "overwhelms" what the liver can process and it eventually fails (keep in mind THIS syndrome is not the primary issue - something causes kitty to go off food - be it an upper respiratory infection, a foreign body, etc)
-gallbladder disease
-cancer
-autoimmune disease - especially one that causes red blood cell breakdown - the pigments are what cause the jaundice - so it's NOT a liver issue, it's call pre-hepatic
-inflammation - cats can get hepatitis, in fact, they often get cholangiohepatitis (inflammation of the gallbladder AND liver)


2. What tests do you think they did?
-a physical exam (ok I know they already did that, but this is often undervalued and overlooked - by clients and doctors as well! - as a KEY component in getting a diagnosis)
-blood work
-an x-ray or two
-ultrasound
-exploratory surgery with biopsies


Ok, they did NOT do all of the above, but they would've all been a reasonable progression in this case.  They did run blood work and they did an x-ray. The blood work was pretty normal but the x-ray showed what looked like a foreign body so they recommended surgery. Skipping the ultrasound saves the client money and the cat time (yes, we cut animals with a problem in less than 6 months! --sorry that's a bit of personal lashing out at some MD's who ignored me). Anyhow, the ultrasound would've said - "hmm..not sure on this...most of it looks normal but the stomach..needs to be opened..so..go in!"


No, they don't really talk but knowing what I know I can tell you that. Ultrasonography has value don't get me wrong. We use it ALL the time. Cases like these are the prime example of why it's just cost and time efficient to "cut to the chase" and cut! 


3. What possible next steps are there for kitty?
Based on what I've said above, you are thinking surgery. True. A very good next step. Sometimes medicine can help though. Fluids and drugs that help things move along through the intestines, antibiotics for liver or GI infections, etc.


And here's what are ALL wondering: What did happen and what did we find to be the cause?


Come back tomorrow and I'll let you see!

What's Wrong with Kitty: Part 2

So, the answer to yesterday's little picture/question was: the cat was icteric or jaundiced - or simply: yellow. The photo was of his  hard palate, one of the places we can see this color change. Other places include the sclera (or normally white part of the eye), just in front of the ears on a cat (the hair is normally thinned there) and the gums. Sometimes, the skin underlying the hair is also yellow.


Let me explain why when we, as doctors and technicians, see this in the exam room and don't immediately say a word. In vet school, one of the cute "phrases" we learned was Yellow Cat=Dead Cat.  A client that comes in with these cats often has no idea just how ill the cat is. In fact, I saw a "yellow cat" case that came in for vaccines. It was only after I pointed out the color on this white coated cat (making it easy to see), she mentioned "oh yeah, he hasn't been eating well.." Needless to say that cat didn't get vaccines, did get hospitalized and did not live long. 


Sadly, that is often the case, no matter the original cause of becoming yellow.


Back to our story though. This is the cute little 4 yr old neutered male: 

He became ill in mid-Dec and went to another hospital. His signs at the time were vomiting and not eating as well. They ran some tests and made appropriate recommendations on how to proceed (yes I am purposely leaving you in the dark on this for now). I want to make you think.   


What are some differentials (possible causes for this) and/or do you have any other questions on info I just gave you? 


What tests do you think they did?




On his exam, they found his ears to be oh-so-slightly yellow and felt something abnormal in his cranial abdomen (or the region closer to his liver/stomach/pancreas).  


What tests would help determine what this could be?


What possible next steps are there for this cat?


Ok, think on it. Throw out some stuff here. I will answer these questions and more tomorrow.


For now, our cat is doing quite well and may go home tomorrow. We are NOT out of the woods yet, however!

What's Wrong With The Kitty In This Picture?

Hint Hint..don't look too hard..and I will reveal the rest of this story tomorrow...it's a good one but the outcome is not certain yet. Praying for a good triad of help - my diagnostic and surgical skills, the healing ability and resiliency of felines and God's hand. 

OMG!! I am IN LOVE!

Before I get to today's blog post, I want to publicly send my sympathies to the Paterno family and friends and to all those deeply affected by the loss (including my dad and other friends of mine). If you were not a Penn Stater or at least close to one, if you haven't really followed them (not JUST the football team ok??!) for years, even decades, you REALLY have no idea what this means to them and what JoePa was really all about (not JUST the football program!)  Sadly, all you have is the media to "show you" the truth, and we all know how all they care about is the truth right?  

Ok, well, it's my blog and I reserve the right to throw something of very personal importance in and hey, I love big cats and the Nittany Lion certainly is one gorgeous kitty! 
------
Anyone that really knows me, knows I love cats. They also know I love polydactyl cats. They ALSO know that I would love a cat with as many extra toes as possible. I know, it's a bit of a genetic mishap, but they are so darn cute!!


Check these cuties out: 28 Toes

My own little poly - Caipurrinha! She has 21 toes - so not a whole lot but still has "mittens" mainly because of the placement on her forepaw first digits (makes her look like a crab foot!).

Hairballs huh?

So I found this cool article about a species once thought extinct being found. Ok, nice. Totally up my alley. Then I read this in it and had to laugh: 

In the past they were hunted to near extinction for their meat and bezoar "stones," he said, which can, on occasion, be found in their guts.


Bezoars, as Harry Potter fans know from lectures given by Prof. Snape to first year students, are believed by some to neutralize poison.


Ok, I remember learning about bezoars in vet school. The one thing I came away with is: it's a fancy sounding word for....wait for it....giant hairball!! Ok, technically that is a trichobezoar, but that is the most common thing we find in animals. 

A Cure for Diabetes...

..at least in humans. It's on the horizon. However, since some of this research involves testing the transplanted cells' abilities to produce insulin in other animals before clinical human trials begin, veterinary patients may be beneficiaries too!


Diabetes is a very common problem in our pet population. There are some breeds that are more prone to it. But, as in people, lifestyle has a LOT to do with it too. Fat pets have a much higher risk than pets at a good body weight. It can be difficult for some owners to treat as most pets are insulin dependent and require twice a day injections. There are also costs associated with treatment and monitoring. 


Here's hoping: 


Check It Out!

Ewww!

Not much grosses me out, hence my life long desire and ultimate achievement  of becoming a veterinarian. However, when learning about a few things, I have to say, I was a bit freaked out. Most of these things were learned in veterinary parasitology class.


Here's one that reminded me of some crazy sci fi movie where aliens invade your liver. Funny enough this was even one of the agents used to attack people in a book called "The Eleventh Plague" by John S. Marr, MD and John Baldwin.


Good book by the way but I AM partial to medical thrillers.


Remember our discussion about tapeworms Monday? As I said, most of them are harmless to humans too. This one is an insidious little bugger. It's the Echinococcus sp. of tapes.


This link is a great quick resource on what it is and what it does, etc from the US National Library of Medicine.  


Basically, once they are ingested, they often find their way to your liver, where they form cysts that may not even show up for years to decades and oh, if they rupture can kill you!  


For a visual of these cysts - in a rabbit:

Here's another great website - one that has some photos and a life cycle as well.  

They Ate What??

I love it when VPI, one of the top veterinary insurance companies, compiles a list of the weirdest things dogs (or cats) have ingested.  


This years list, with some pictures, is here.

Unpleasant But (Mostly) Harmless

I'm referring to tapeworms. These are fairly common parasites in our dog and cat population.  


There are a number of species and some infect both cats and dogs. There are also some that are zoonotic, which means than can be infective to humans. Fortunately this is rare.


There are two main sources of tapeworm infections in pets:


1. Hunting and ingestion of rodents, rabbits and hoofed animals, such as sheep, deer, etc.


The latter group happens when an animal dies or is hunted or slaughtered with remains, intestines, etc left to be scavenged - be in a field or on a farm.


2. Fleas


Of course, it's important that every pet that comes in for an exam be checked for fleas, which is very easy to do with the use of a flea comb. Parting the hair is not enough. I have done this and missed fleas or flea "dirt" (feces) which was subsequently easily found by combing. 


Tapeworms generally cause no major signs or problems for pets. They are infected with low numbers of adults. They are also not generally diagnosed like most other intestinal parasites which is via fecal flotation. This is because the eggs are generally heavier and more sporadic, they are not often seen. The most common way we know is that the owner or a veterinary professional or groomer, sees the "rice like" segments under the tail or by the rectal area. 


Finding tapeworms should always result in a search for fleas and if not already being done, having the pet on monthly flea and tick prevention. 


Tapeworms are very easy to treat. There are several medications that are quite effective, including a topical product for cats. However, if the cat is going out and hunting regularly, its important that they get a broad spectrum dewormer (my personal favorite is fenbendazole because of all it covers) at least 3-4 times a year. 


The Companion Animal Parasite Control Council Website is an informative and reliable resource about all pet parasites, control and public health concerns.

A Dream Job!

You all know how much I loved my time at the zoo. Busch Gardens in Tampa is opening a brand new veterinary hospital that allows visitors to see all sorts of stuff - surgeries, pathology samples, etc.


I think that's very cool. I personally would love to work at a place like this - state of the art stuff and you can do what needs to be done for the animal. Period. You don't have to deal with difficult clients or pick and choose based on cost what you are going to do for that animal. 


Check It Out!

This week look for some "meatier" educational topics. 

Maybe Dogs Have 9 Lives Too!

Here's a great story about a dog surviving in the wilderness after an avalanche killed his owner.


The Corgi in Montana

Your Bad Habits CAN Affect Your Pets

Smoking has been shown to affect the health of our pets. This column briefly discusses what veterinarians have known for years about cats living in the homes of smokers. When you think about it, it is common sense. If second hand smoke is bad for me, why wouldn't it be bad for Fluffy or Fido? They breath it in and they ingest the smoke that falls on their coats. This very same smoke we all know is full of carcinogens.


I have discussed this with pet owners before - especially cat owners. This is mainly because of the studies that back up the claim - the increased incidence of lymphoma being one of the most well known issues.  It may be the incentive they need to quit smoking as so many people take better care of their pets than they do themselves! 

I Miss the Zoo!

I enjoy reading these articles (well, not the "sad" stuff so much) because it reminds me of the wonderful year I got to spend working at the Cape May County, NJ Zoo


A geriatric Cougar was recently euthanized a small zoo after facing multiple health issues and declining quality of life. Sad. But clearly the right thing to do. 

A Snowy Owl is being treated after hitting a car. This link also has a video.

The Positive Outcomes

The past few days have been uplifting because I saw two cases that, when they were first presented to me, I thought  were not going to make it.


1. A young kitten found by one of our health care team members and not long after adopted out by a nice young man. He took it home on the weekend and a few days later, the kitten came in flat out and with serious neurologic issues. No history of trauma or toxicity. This kitten turned out to have an infection, but I still don't know what kind or how it even happened. We treated it and slowly he got better. He was hospitalized for a week. That was last fall. Today he's a gorgeous kitten full of life! 


2. A young beagle gets hit by a car in the head and the owners rush her in. She is also flat out and non responsive. There is very clear head trauma here. We stabilize her but she needs much more intensive care. The diligent owners bring her to the speciality care center we recommend and she goes home in less than 48 hours. That was many months ago. Today she is an adorable but a bit shy young adult!


It's cases like that why I almost always have hope. There are two things that helped these cases (yes, besides attentive owners and great veterinary care by docs/techs alike!):
-youth - always a bonus
-being a cat - where do you think the saying about 9 lives comes from? 

Pets As Models for the Business World

I have always believed we can learn a lot from animals. Even in my own home, with 6 cats and 1 dog, I have sometimes found amazing "insight" into things from their perspective. Here's one example:


I have 6 cats - who all act like they have never eaten. In the morning, I split a can among all of them. They all clamor, meow, and maneuver for the bowls. Some are more dominant than others. The most impatient ones stick their heads in the bowl before I can barely get any in, while I may have a slightly larger amount ready for the next bowl. One day, that literally spoke to me out of my own faith in God and my frequent impatience to make things happen and in "my" time. I realized, that like my own cats, by "jumping the gun" on God's leading in my life, I may very well be missing out on the better things He has in store for me. Trust me, it's a lesson I needed and continue to need. 


I am sure I could come up with many more examples but that is the one that truly hit hard one day! 


I found this article on How You Can Be a Better Leader By Watching Your Pets

Heartwarming Story: A Good Reason to Microchip!

The only caveat I have on this: please if you DO have your pet microchipped, register them! I have seen a few cases of a "stray" found with a chip but no address connected to it! 


Microchipping is another inexpensive, safe, and easy insurance policy for your pet. Your pet is not "tracked" with the chip. The chip has a number that is connected to the address where you live, which can easily be changed when needed - on line or via phone!


All of my 7 pets - 6 indoor only kitties and 1 dog - are micro chipped!  This "procedure" is simply an injection of a chip, using a little larger bore needle than we use for vaccines. It can be done during a spay/neuter for those younger animals or anytime during puppy or kitten hood or the older pet who has found a new home!


Never Give Up Hope If You Have a Microchip!

9 Lives...or more?

Just read this:  Cat Survives Two Attempts To End Her Life

Education

I was at a Starbucks the other day (I know, simply shocking! -hahaha for those that truly know me) and ran into a barista I knew from my former frequent stops to that location. She knew I was a vet and told me she had gotten a puppy since we last talked. She told me the breed and the age (a 6 mo old Boston terrier) and then asked where I worked. She said she had "called around" to find prices on things. She knew the dog was due for vaccines.


Red flag one. At 6 months, unless a stray, the dog should be finished with his vaccines.  I asked her how long she'd had the dog. 3 months was her answer. When was his last vaccination? Before she purchased him. So the last vaccine the dog received was null and void. Puppies need vaccines every 3-4 weeks, generally starting at 8 weeks and continuing until 16 weeks. The immune system responds a certain way. Period. If you miss the window, you have to start over again. 


Red flag two. If you have to call around for prices on basic care, the timing of a pet in your life may be wrong. I am all for pets and how much they add to our lives. However, they are still a luxury. Even the basics cost money and there are always unforeseen illnesses and traumas. I advised her that seeking a vet based solely on prices was not a good idea. It's fine to try to save money but you should talk to people with pets - friends, neighbors  - see who they use. Every vet is not for everyone. If you want a "shot and a beer" type of place - ie, a vaccine clinic at a PetSmart - that's fine. But remember, you have no relationship with a vet - no valid veterinary/client/patient relationship to fall back on when "Fluffy" gets sick. You are then simply a "new client" - less likely we will stay late if you call at 5 till closing. Just keep that in mind. You want to find someone you trust and are comfortable with and who communicates with you. 


This little conversation brought to mind how I feel such a need and passion to educate. This young girl didn't even realize the importance of her puppy's vaccinations. I just don't know how to reach those who don't know. I am hoping this blog is one such avenue. 

A Look Back

Happy New Year!!


As a new year starts, it's reasonable to assume most of us take a look at the year that has gone by and assess our lives -personally and professionally.  The veterinary industry is no different. This article takes a look at the top 10 issues (not just problems but trends, stories, etc) the industry faced last year.


The list is (the article provides more detail but is a quick slideshow type read):


1. Pet ownership jumps 2.1 %
2. Competition with "Dr. Google" (one of my biggest issues!)
3. Acts of heroism
4. Prevention is better than treatment
5. Supply and Demand of us DVM's
6. New competitive pressures
7. Heartworm treatment??! 
8. Drug shortages
9. Student debt and the future (debt went up, salaries went
                                                down - bad combo)
10. Where veterinary education is going in the future