What You Don't Know ....

....can hurt you.  Yesterday was a prime example. Well, today too...as this case bled into two days. No,  not literally but the case came to me yesterday and my wonderful friend and boss had to deal with it today. 

So this particular case illustrates that often times as good as WE think we are as pet owners, we aren't. We think we know what our pets do and don't do. But I can tell you all - and I am guilty here too - no, we don't. I,  personally, had a cat that was obsessed with string like objects that found them no matter what I did! He even destroyed a few pieces of clothing with appropriately sized string (one a robe, the other a sweater) and CONSUMED these things! Yes. Fortunately for him and me, we didn't have to take him to surgery.  Here is a prime example of unknowns happening....

So this dog ate some foreign bodies and developed what we call an intussception ( telescoping of intestines)  as well as having some intestine that was dying, and the owner truly had no idea.  None. Never saw it happen, etc. This was a puppy...which is often the worst offender. Puppies - cute but good at subterfuge! Until....they get sick. Sadly, this dog, despite the best medicine, did not make it and makes us realize, we are often clueless to reality. 

We  - meaning those in veterinary medicine and those that are pet owners - learn the most from the things that hurt us all the most. Sweet girl pictured here had more than enough love to save her but sometimes it's beyond even that. 

When Positive Is NOT A Good Thing

The photo above shows a feline combo or feline leukemia  
(FeLV) / feline immunodeficiency virus test (FIV).  The center blue dot at the top - the 12 o'clock if you will - is the control dot. That dot should appear every single time the test is run as it means it ran correctly. 

The dots you see that are at the 3 and 6 o'clock positions are positives for feline leukemia and FIV, respectively. 

This test is from a stray cat that was brought in the other day by a good Samaritan who has been seeing this cat outside of her home most days for the past year. He was friendly enough to touch and the other day, after going missing for over a day, came back clearly in distress and not moving well.

He was unable to stand and crying and his exam revealed severe infections in three of his four feet, a suspected joint infection in his left elbow (very swollen and painful) and/or trauma to that leg and overall depressed mentation. 

Though the "owner" was willing to take responsibility for further diagnostics, the first thing we always do is this test. This sad case is a perfect example of why we insist upon it. 
With radiographs and other tests and medications potentially adding up to hundreds of dollars, not to mention the likelihood this cat would not recover as expected, this test saves everyone a lot of further heart ache.  The cat included.

This cat has been infected, and is now clearly clinical, with two immunosuppressive feline viruses. He is the poster child for FIV - an un-neutered male cat who has been seen fighting with at least another cat in the area. FIV is spread via fights and bites as well as sexually. Feline leukemia is spread via close intimate contact (grooming, sharing food/water bowls, etc) and transplacentally, meaning it can be passed on to the kittens. 

The kindest thing to do for this cat was to euthanize him. Even if he was not sick and merely positive, he could not live with any other cats AND he certainly should not be put back outside spreading these viruses to other cats, reproducing and potentially creating positive kittens. A cat with one or both of these viruses is also more prone to infections and they are more likely to be serious, therefore they need to be kept inside for that reason as well. 

We know cats can survive a long time with FIV alone. They should be kept indoors. They can live with other cats if there is no intense fighting (enough to cause punctures) among the cats in the household. 

It's the FeLV that's the kicker here. Cats that are infected rarely live past 2-3 years. 

AND this cat has both viruses - truly a no win situation for him.

As we assured the kind lady, it is nice that he didn't have to suffer outside in the cold, unable to get food and water and starving to death outside. Sometimes that's just part of being an animal lover. 

I'll discuss prevention and other aspects of these diseases in my next blog post.

It's Almost Time for Lyme

I'm going to be very honest with you. I truly DO take for granted sometimes what people know, get and understand. No, these are not deep medical secrets, things only students of anatomy, physiology or pharmacology would know. These are things I know are "out there" in the media and that pet owners talk about. Things that pet owners often worry about getting themselves and see their own doctors about.  The thing is, often what they know isn't accurate. It certainly is not tailored to their pet or where they live. 

Lyme disease is one of the most common things I diagnose, year in, year out here in the Poconos. Northeast PA has the highest incidence in human and dog cases per the CDC. FYI - cats for whatever reason, are immune to it (see, I told you cats were amazing!). Anyhow, what upsets me the most is that this disease, while endemic to this region, is preventable. 
However, if patients are not properly protected, they can die from it. 

Lyme nephritis is kidney failure cause by the Lyme bacteria. The bacteria cause an immune response whereby immune complexes clog up the tiny little glomeruli (or filters) in the kidneys. There is NO treatment once we reach this point. Lyme nephritis, in my personal experience of 15 years, does not seem to hit those dogs that are routinely vaccinated. Dogs with Lyme nephritis can live a few days to weeks (rarely months) with medications, fluids, etc. However, they are doomed. Even if they are 2, 3, 5 years old, etc. Trust me, I've had to be the bearer of the news I dread to deliver. I've had to euthanize otherwise healthy young dogs with years left because they didn't have a  $25 vaccine on board. Yes. It sucks. 

Even a vaccinated dog can and often, in our area, does test positive for Lyme on the 4Dx Snap test. The test does NOT get a false positive from vaccine and is only positive from active infection. Therefore, that tells me that the vaccine offers a HUGE protection in clinical disease to our dogs. There is NO reason not to vaccinate a dog, unless he or she has cancer or some other massive immune system issue where vaccines are a problem. This is a very RARE circumstance. Even indoor little "foo foo's" that supposedly never go out have tested positive in my practice settings. 

Dogs usually test positive months after exposure to an infected tick. They will not test positive from a tick you pulled off the day or week of your visit with us. 

If your dog tests positive, I WILL treat him or her with a month of antibiotics. In a year, we will want to check an antibody level. However, you should continue to (or start) vaccinating your dog for Lyme (it's always a series of 2 vaccines initially, then yearly) and using an effective product like Vectra (any topical needs to be applied more frequently if you bathe or swim your dog a lot.) Lyme re infections can occur at any time. This is not chicken pox in humans.

So when we ask or recommend that your pet get tested, it's not because we want to make more money. It really is not! I can assure you.  There is nothing more upsetting and maddening to me to have to tell someone their pet is going to die (from something that could have been prevented with proper care and listening to or even going to a veterinarian). Please understand and follow our recommendations. If you don't trust your vet, please find one you do. There are a lot of things we cannot prevent or change or predict. However we work very hard at the things we can! 

This is Normal

During a vaccine clinic this past weekend, a volunteer for No Kill Lehigh Valley asked me to send her the pictures of the cat pyometra and a normal uterus. 

I wanted to share those pictures with you so you could also see the massive difference between normal and infected uteri.    The surgical instruments in both pictures are the same. They are from a small spay pack. That should help give you perspective too! 

A reminder of what the infected uterus looks like:

Please have your cat (or dog) spayed when your vet recommends it. Generally for cats 6 months is fine.  If you adopt an older cat and she's not spayed, it's not "too late." Age is not a disease but a pyometra is and a potentially fatal one at that. 

A Hard Lesson

I'm sometimes surprised about what surprises me in this profession. A case last from last week is a good example.

A new client came in with an 8 yr old overall "healthy" cat because she saw some discharge from the "back end." Of course, there are a few possibilities with that description. The cat was indoor only and lived with her two other female litter mates. All of the cats were unspayed. 

Her reason for not spaying was them was she thought that the (one) reason for spaying - to prevent pregnancies - was eliminated because she kept them strictly indoors. This was NOT a wrong thought.

What she didn't know were that:
1. Having a uterus makes them possible candidates for developing a serious infection called a pyometra
2. Have a uterus/ovaries makes both dogs and cats have a HIGH incidence of mammary tumors later in life with cats having an 80% chance of them being malignant (dogs it's 50%). 

As I examined this sweet little kitty (she was only about 8 lbs), I felt her abdomen was rounded/distended and felt a bit abnormal (I could not palpated distinct organs) but the owner hadn't noted any changes in her "shape or size." Her appetite had been good so maybe she was a little bigger because she was older and not as active.  Also this whitish discharge (pus) was coming from her vulva. 

My years of experience screamed - pyometra. We ran some blood work to make sure her organ function was ok and that she was also feline leukemia/feline immunodeficiency virus negative.  I also put the ultrasound probe on her belly and found large pockets of fluid, consistent with a pyo.  Her blood work was all good except for a moderate anemia, which often goes along with chronic infections, and a high white blood cell count, consistent with our pyometra.

The only way we could save her was to do emergency surgery on her. 

So we got her admitted and over lunch break, did her surgery. In my 15 years of experience she was the weirdest and worst case (especially for a cat) I have ever seen. I will share some pictures below. At first I was baffled as to why I couldn't get the rest of her uterus out - the cranial portion of the horns on either side where we find the ovaries as well. I thought she had some massive adhesions at first (she had a few minor ones as it turned out but that was not the cause of the difficulty) , which was definitely possible given the inflammation going on inside her. However, as I enlarged the incision it became clear to me the uneven pocketing of pus that was going was creating a much larger portion of the horn than we typically see. It's usually just a very enlarged "Y" but evenly enlarged. Not in this case as you can see from the pictures.  Remember, this little girl is 8 lbs.

The large portions were very firm too so once we had them out I wanted to cut into them to make sure they weren't some type of mass. As it turned out, it was simply pus. 

The sweet girl made it through surgery just fine. She was carefully monitored by our wonderful surgical nurses. She had her antibiotics on board and her IV fluids running. She woke up and was extubated just fine, however, she never really came around. She continued to be very listless despite warmth and tender care and then her body temperature started to plummet and we lost her a mere hours post op.

Why you may ask? Well, she was very little and clearly this had been going on for longer than the owner could've have known. There is a very good chance she was septic (bacteria in the bloodstream from this very severe infection)  and that will often cause organ shut down in spite of what we do. We weighed her after surgery and she lost over 1 lb! That's how big her uterus was. That too could have been a bit of shock to her system. However, the flip side is if we did nothing, that uterus would've ruptured and she would've died a painful death. It was a lose/lose. 

This was a hard lesson for both the owner and me. The owner wasn't aware of the (other) dangers of not spaying and I thought for sure I could save her (call it a bit of pride in what I do and how I do it.) 

The one positive outcome is that she is now going to have her other two cats spayed and she has become a wonderful client. And we both learned something. 

Normally the enlarged uterus is symmetrically enlarged and in a cat, typically only as large as the lower portions - closest to the end of the "Y" that you see here - (not the BIG pockets)

I was happy to find only pus in these large pockets. 

One of our nurses, Kara, holding her in a warmed towel as she wakes up from surgery.

After the Respite

It has been a while since I've come in here and shared anything with you. I hope that I still have your interest and attention but if not, it's certainly incumbent on me to regain it.

At times I feel like the same things are said over and over, yet no two days in veterinary medicine are truly the same. So my perfectionism has, perhaps, gotten the best of me and caused me to pause in my writings. 

There are many things that come up each day in practice that surprise me or show themselves as educational points. I now run the practice Facebook page, so I've been using my time and focus on that. If you are interested click on this link: Pocono Peak Veterinary Center

But here's an article of interest that I've known about for a while. By the way it's not the only article about it. There are others from other sources. Everything has unforeseen (or maybe even seen but not cared about) consequences. Things that may not seem at first to impact on our businesses and lives, at further glance, do. In this case, legislation that affects such a huge portion of our budget and lives, most certainly has an impact on small businesses like veterinary offices. While healthcare laws do not impact us like our human physician colleagues, anything that impacts the economy will hit us too. Our business is dependent upon disposable income. We operate under free market principles. It's a beautiful thing. Competition leads to lower costs for clients, increasing skill allows us to (rightfully) earn more, and transparency makes everyone responsible for what they spend. There's no overuse on something you feel the cost of AND there's no one telling me how to practice. Thank God!

 ACA Impacts Veterinarians shows just a few things that will happen as this rolls on. Of course I don't have to tell you when there are less jobs and lower incomes, we can certainly expect people to budget differently and spend less on their pets. We are already seeing these effects which are likely to only get worse. Pets don't come in until much later in a disease process or worse, we are seeing pets abandoned when people lose their jobs or homes. 

Don't worry though, we are a very stubborn hard working group of people. We didn't get into this for the money (we knew we'd be in debt and could've done a lot of other things) but we do need to pay our bills too. We are creative and innovative and won't let anyone stand in our way of doing what we love. I, for one, will continue the good fight!